Purpose: Emergency laparotomy carries high morbidity and mortality. The NZRISK score is a validated perioperative risk model for 30-day mortality for patients in New Zealand undergoing non-cardiac surgery1. We retrospectively applied NZRISK to emergency laparotomy patients to evaluate its relationship with postoperative outcomes and inform future quality improvement. Methodology: A retrospective review of 126 emergency laparotomy patients was conducted from September 2023 to September 2025. NZRISK scores were calculated using perioperative data extracted from clinical records. Primary outcomes included postoperative ICU admission, major complications (Clavien-Dindo III-V), and 30-day mortality. The association between NZRISK and 30-day postoperative mortality was assessed using the Cochran-Armitage test for trend. Statistical significance was set at p<0.05. Results: Of 126 patients, 53 (42.1%) had a low NZRISK score (<5%), 36 (28.6%) had a moderate score (5-10%), and 37 (29.4%) had a high score (>10%). Within these groups, there was a 30-day postoperative mortality of 1.9%, 8.3% and 24.3% respectively. The trend test demonstrated a significant linear increase in mortality across NZRISK groups (χ²=11.44, p=0.0007). ICU admission was more frequent in higher risk patients, with 24.5% in low risk, 52.8% in moderate risk, and 59.4% in high risk. Major postoperative complications were also observed in higher NZRISK groups, with 11.3% in low risk, 22.2% in moderate risk, and 29.7% in high risk. Conclusion: Higher NZRISK categories were associated with stepwise increases in 30-day mortality, ICU admission and major complications. Further validation studies are required with higher sample size in multiple centres. References: 1. Campbell D, Boyle L, Soakell-Ho M, et al. National risk prediction model for perioperative mortality in non-cardiac surgery. Br J Surg. 2019;106:1549–57.