The Physiological Emergency Surgery Acuity Score (PESAS) effectively predicts 30-day mortality and anastomotic leak in patients undergoing emergency laparotomy.

• In a study of 1,086 patients, PESAS demonstrated strong discrimination for 30-day mortality (AUROC 0.86), with a mortality rate of 14.7%.
• For a subset undergoing bowel anastomosis, PESAS also predicted anastomotic leak (AUROC 0.82) with a 5.1% leak rate.

PESAS, based on objective physiological variables, may enhance automated risk stratification in emergency general surgery, though further validation is needed before widespread adoption.