Abstract
BACKGROUND: Urgent abdominal operations represent a large proportion of surgical care and are associated with substantial morbidity and mortality. Evidence is scarce from low- and middle-income countries (LMICs), including Latin America (LA). The lack of regionally representative outcomes data hinders quality-improvement efforts and understanding of modifiable risk factors that could be targeted to improve urgent care. METHODS: We present results from a prospective, multicenter observational cohort study of urgent abdominal surgery conducted in 14 countries across Latin America between February and December 2024. Eligible participants were consecutive adults (≥18 years) undergoing urgent gastrointestinal operations at each site during a 6-week inclusion window. The primary outcome was 30-day mortality. Secondary outcomes were reoperation, readmission, time to discharge, and prolonged intensive care unit (ICU) stay (defined as >72 h). Bayesian time-to-event models and Bayesian logistic regression were used to estimate associations between the outcomes and pre-specified covariates (age, sex, obesity, center volume, Charlson Comorbidity Index, SOFA score, surgical approach, operative time, prior abdominal surgery, intraoperative complications). FINDINGS: A total of 1015 patients were included from 89 hospitals (mean age 58.3 years; 50.4% female and 49.6% male). The most common indications for surgery were intestinal obstruction (46.8%), perforation (23.4%), and abdominal abscess (9.6%). Overall 30-day mortality was 12.6% (128/1015) and one in three of these deaths occurred within 24 h of the index operation. Prolonged ICU stay occurred in 27.9% of patients, reoperation was required in 18.4% and readmission in 4.9%. Across all models, we consistently found an association between Charlson Comorbidity Index >3, SOFA score >3, and open surgical approach with higher odds or hazard of adverse postoperative outcomes, including death. Patients with SOFA >3 had substantially increased odds of prolonged ICU stay and higher hazard of reoperation and death. In contrast, open surgery was associated with longer hospitalization and more reoperations, as well as higher mortality. INTERPRETATION: This large multi-country cohort provides the first region-wide estimates of outcomes after urgent abdominal surgery in Latin America. Mortality remains high, with almost one-third of all deaths occurring in the first 24 h after surgery. Patients' comorbidity burden, physiological derangement at presentation, and operative approach are all key determinants of outcome after urgent abdominal surgery. This evidence provides a baseline for quality-improvement efforts and highlights the urgent need for region-specific guidelines and protocols to standardize urgent surgical care across Latin America. FUNDING: This study received no external funding. All centers contributed in-kind resources, including personnel and data-collection infrastructure.