Predicting Reoperation After Emergency Laparotomy: The Role of Postoperative Inflammatory Markers

Giulia Romano¹, Marco Donati², Enrico Bellini³, Alessia Conti⁴

Abstract

Abstract:
Background: Early identification of patients at high risk for reoperation after emergency laparotomy can reduce morbidity. This study evaluates the utility of postoperative inflammatory markers in predicting surgical failure within the first 7 days.
Methods: A prospective observational study was performed on 348 patients undergoing emergency laparotomy in three hospitals in Italy (2021–2023). CRP, PCT, WBC, and serum lactate were measured on postoperative days 1, 3, and 5. The primary outcome was unplanned return to the operating room. ROC curve analysis assessed diagnostic performance.
Results: Unplanned reoperation occurred in 63 patients (18.1%). On day 3, CRP >220 mg/L (AUC = 0.85), PCT >1.5 ng/mL (AUC = 0.79), and lactate >2.2 mmol/L (AUC = 0.76) were strong predictors. A combined CRP+lactate model reached 88.2% sensitivity and 81.7% specificity (AUC = 0.89).
Conclusion: Postoperative CRP and lactate levels are reliable early indicators of surgical complications requiring reintervention. Biomarker-guided monitoring may improve surgical decision-making and reduce delayed reoperations.