Postoperative pulmonary complications are a major threat in emergency laparotomy, significantly impacting patient survival.

• Pulmonary complications occur in 20-40% of patients and are linked to a mortality rate of 42.1% versus 11.9% for those without.
• Key predictors for these complications include ASA score and gram-negative multi-drug resistant organism colonization.

Taking action on antibiotic therapy for high-risk patients could help reduce these life-threatening complications.

• Targeting these predictors may reshape perioperative guidelines for more vulnerable emergency cases.