TPT 3.17 The Impact of Deprivation and Geography on Emergency Laparotomy Outcomes: A Systematic Review and Meta-Analysis
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ID: 323983
2026
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Abstract
Abstract Background Emergency laparotomy carries a high risk of mortality, yet it remains unclear whether survival is dictated by systemic barriers such as socioeconomic deprivation and geographic isolation. We aimed to determine the effect of deprivation and geographic location on operative mortality following emergency laparotomy. Methods MEDLINE, Embase, PubMed and Cochrane Library were searched for studies comparing outcomes based on socioeconomic deprivation or location. Statistical analysis was performed using RevMan 5.4; meta-analysis employed random-effects models. Geographic data were synthesised qualitatively. Results Nine studies (n=3,561,896) were included. Meta-analysis of five studies demonstrated a significant association between socioeconomic deprivation and unadjusted operative mortality (Odds ratio [OR] 1.56, 95% confidence interval [CI. 1.05–2.30]; z=2.23, P=0.03). However, this effect was attenuated and lost statistical significance after adjustment for clinical confounders in four studies (OR 1.14, 95% CI [1.00–1.31]; z=1.91, P=0.06). This suggests deprivation acts primarily as a proxy for preoperative physiological derangement. Geographic synthesis of four studies revealed that prolonged travel time was not associated with mortality; instead, remote cohorts often demonstrated paradoxical survival benefits. Distinctly, semi-urban areas were identified as high-risk zones for mortality and damage control surgery compared to true rural areas. Bridging these domains, low socioeconomic status was independently linked to a 25% higher laparotomy incidence and peritonitis regardless of distance. Conclusions Socioeconomic deprivation serves as a marker for higher acuity rather than an independent determinant of operative survival. Geographic risk is defined not by physical distance, but by specific "micropolitan" phenotypes and deprived demographics associated with delayed, high-acuity presentation.
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| Authors | Abir Mamun, Yahya El-Tahlawy, Yumna Saleem, Omar Lubbad |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag087.200
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| URL | |
| Keywords | Keywords not found |
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