Determinants of Surgical Mortality in Emergency General Surgery: A Multivariate Analysis at Three Teaching Hospitals in South South Nigeria

Emergency general surgery carries a disproportionate burden of preventable mortality in Nigeria, yet robust multivariate analyses identifying independent predictors of surgical death in the South South geopolitical zone are lacking. This study determines the independent determinants of in-hospital surgical mortality following emergency general surgery at three teaching hospitals in Rivers, Edo, and Delta states from 2020 to 2023. A retrospective cohort of 600 emergency surgical admissions was assembled, with in-hospital death as the primary outcome. Candidate predictor variables included age, ASA classification, preoperative shock, indication for surgery, intraoperative blood loss, duration of surgery, and postoperative organ failure. Binary logistic regression with backward elimination was applied. Independent predictors of mortality included ASA class III or above (OR 4.2), preoperative hypotension (OR 3.8), intraoperative estimated blood loss exceeding 1500 ml (OR 5.1), and postoperative pneumonia (OR 3.3). Surgical indication was not independently significant after adjusting for physiological status. The overall mortality rate was 14.3%. The study provides an empirically derived risk model that can guide resource allocation and preoperative counselling in South South Nigeria. Recommendations include structured preoperative resuscitation protocols, high-dependency unit development, and risk-stratified audit systems at each participating institution. Keywords: surgical mortality, emergency surgery, multivariate analysis, South South Nigeria, predictors