366 The Effect of Surgeon Subspeciality on Outcomes in Emergency Upper Gastrointestinal Laparotomy: A Systematic Review & Meta-Analysis

Abstract Aim Emergency laparotomy is associated with a high risk of mortality, and outcomes may be influenced by surgical subspecialisation. This study aimed to compare postoperative outcomes following emergency laparotomy for an upper gastrointestinal (UGI) pathology between UGI subspecialists and other general surgeons. Method A systematic review of MEDLINE, EMBASE and Cochrane Library databases was conducted for studies published between January 2000 to June 2025, reporting the influence of surgeon subspecialty interest on outcomes following an emergency laparotomy for UGI pathology. Meta-analyses of the primary (30-day postoperative mortality) and secondary (length of inpatient stay) outcomes were performed using fixed-effects modelling. Results Six non-randomised studies (n=10,276 patients) were eligible for inclusion. Overall, 3114 patients were treated by an upper gastrointestinal subspecialist (30.3%), with the remainder managed by a colorectal surgeon or other general surgery specialist. Meta-analysis of proportions estimated a mortality rate of 13.4% (95% CI: 10.0% to 17.0%) for specialists undertaking an UGI emergency laparotomy, and 16.9% (95% CI: 9.0% to 30.0%) for non-specialists. Pooled adjusted odds ratios demonstrated that an UGI specialty interest was associated with lower 30-day postoperative mortality (OR: 0.84 [95% CI: 0.75 to 0.94], p=0.003) and reduced postoperative length of stay (IRR: 0.91 [95% CI: 0.90 to 0.92], p<0.001). Conclusions Emergency laparotomies for UGI pathology are associated with lower rates of mortality and shorter hospital stays when performed by an UGI subspecialist. These findings highlight the value of subspecialist involvement in emergency general surgery care for complex or high-risk UGI pathology.