Emergency abdominal surgery: variation in closure practice and early postoperative outcomes in the prospective multicentre PROPHECY study

Abstract

Emergency abdominal surgery carries a high risk of postoperative morbidity, yet prospective multicentre data on real-world abdominal wall closure practices remain limited. This interim analysis of the PROPHECY study aimed primarily to characterise current abdominal wall management and variation in practice across centres, and secondarily to describe early postoperative outcomes. This prespecified interim analysis included adult patients undergoing emergency abdominal surgery in a prospective multicentre cohort across Poland (June–December 2025). Patients were grouped by operative access (laparotomy, laparoscopy, conversion). Closure practices and early outcomes, including surgical-site infection (SSI), fascial dehiscence, major postoperative morbidity (Clavien–Dindo ≥ III), in-hospital mortality, and length of stay, were assessed. Multivariable mixed-effects models with a random intercept for centre were used where applicable. Of 850 screened patients, 828 from 24 centres were included; 273 (33.0%) underwent laparotomy, 500 (60.4%) laparoscopy, and 55 (6.6%) conversion. Substantial variation between centres was observed in abdominal wall management, particularly in the use of short-stitch closure, subcutaneous drainage, and prophylactic negative-pressure wound therapy, whereas fascial closure of larger camera ports was nearly universal. Prophylactic mesh reinforcement was uncommon. SSI occurred in 9.3%, fascial dehiscence in 2.4%, major morbidity in 11.2%, and in-hospital mortality in 3.0%. Differences in early outcomes between operative approaches persisted in adjusted analyses but should be interpreted in the context of substantial differences in case-mix and potential residual confounding. Emergency abdominal surgery is characterised by substantial variation in abdominal wall management across centres despite existing recommendations. This prospective real-world benchmark identifies areas of inconsistent practice and provides the clinical context for the planned 12-month assessment of incisional, port-site, and parastomal hernia outcomes in the PROPHECY cohort.