Impact of nutritional status on 30-days postoperative morbidity and mortality in patients undergoing emergency laparotomy for gastrointestinal perforation peritonitis: a prospective observational study

BACKGROUND: Malnutrition is an under-assessed risk factor for poor surgical outcomes in emergency settings. Emergency laparotomy (EL) for gastrointestinal perforation peritonitis presents a unique challenge due to its acute nature and associated sepsis, which often compromise preoperative nutritional optimization. This study evaluates the impact of preoperative nutritional status on 30-days postoperative morbidity and mortality following EL. METHODS: In this prospective observational study, 105 adult patients undergoing EL for gastrointestinal perforation peritonitis were assessed for nutritional status using CONUT and MUST scores. Postoperative complications were graded using the Clavien-Dindo Classification (CDC). Patients were stratified into high and low risk based on nutritional score thresholds, and complications were grouped as minor (CDC Grades I-II) or major (CDC Grades III-V). RESULTS: A significant proportion of patients were found to be moderate to severely malnourished (66.67% per CONUT, 40% per MUST). Major complications were observed in 38.1% of patients. All recorded deaths occurred in those with moderate to severe malnutrition. Strong correlations were found between higher CONUT/MUST scores and complication severity (ρ = 0.631 and 0.539, respectively; p < 0.001). ROC analysis demonstrated that CONUT had superior predictive ability for 30-day mortality (AUC = 0.949) compared to MUST (AUC = 0.843). Length of hospital stay (LOHS) was also significantly prolonged in patients with high nutritional risk. CONCLUSIONS: Both CONUT and MUST demonstrated good predictive performance, with no statistically significant difference on DeLong comparison. The implementation of nutritional assessment may enable timely interventions, reduce complications, and improve survival outcomes in patients undergoing EL.