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2026, Vol: 10, Issue: 3
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Review Article
Online Published: 02 Jan 2026
 


POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis

Hosam Hadi Awaji, Abdulkareem Abdulrahman Ajaj, Lujain Ali Awkar, Murad Ali Sharif, Ahmed Jarallah Alrashidi, Abdullah Mastour Alotaibi, Fawzeyah Suliman Alnakhli, Safiyah Abdullah Almuhalbidi, Khalid Mohammed Almutawa, Abdulaziz Saad Aljohani.


Abstract
Artificial intelligence (AI) has progressively been used in surgical decision-making, especially in emergency and trauma surgery. The Predictive Optimum Triage and Treatment Evaluator for Rapid Response (POTTER) is a novel AI-based risk assessment algorithm designed to improve preoperative planning and outcome forecasting. Nonetheless, its prediction accuracy and practical applicability remain ambiguous in comparison to established scoring systems as the American College of Surgeons Surgical Risk Calculator (ACS-SRC) and the Emergency Surgery Score (ESS). This systematic review and meta-analysis aimed to assess the predictive efficacy of POTTER in emergency general and trauma surgery, juxtaposing its accuracy with ACS-SRC in forecasting postoperative morbidity, mortality, and other critical surgical outcomes. A thorough literature review was performed to uncover papers comparing POTTER with ACS-SRC in emergency and trauma surgical contexts. A meta-analysis was conducted to evaluate discriminative capability by aggregated C-statistics and logit differences. Heterogeneity and bias risk were assessed to guarantee the robustness of the findings. The investigation revealed that although POTTER is a proficient AI-driven predictive instrument, surgeon-based evaluations (ACS-SRC and ESS) displayed enhanced discriminative efficacy in forecasting 90-day death (23% higher AUC), overall morbidity (19% higher AUC), and renal failure (21% higher AUC). Nonetheless, POTTER proved to be a valuable and comprehensible paradigm, especially in instances of septic shock and extended ventilation. Notwithstanding its promise, POTTER failed to surpass conventional surgeon-based grading systems in emergency general and trauma surgery. Additional refining and empirical validation are necessary before AI-driven models such as POTTER might supplant current risk assessment instruments.

Key words: Emergency general surgery, risk prediction, POTTER, ACS-SRC, systematic review


 
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How to Cite this Article
Pubmed Style

Awaji HH, Ajaj AA, Awkar LA, Sharif MA, Alrashidi AJ, Alotaibi AM, Alnakhli FS, Almuhalbidi SA, Almutawa KM, Aljohani AS. POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis. IJMDC. 2025; 9(12): 3376-3386. doi:10.24911/IJMDC.51-1765562673

Web Style

Awaji HH, Ajaj AA, Awkar LA, Sharif MA, Alrashidi AJ, Alotaibi AM, Alnakhli FS, Almuhalbidi SA, Almutawa KM, Aljohani AS. POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis. https://www.ijmdc.com/?mno=303023 [Access: January 16, 2026]. doi:10.24911/IJMDC.51-1765562673

AMA (American Medical Association) Style

Awaji HH, Ajaj AA, Awkar LA, Sharif MA, Alrashidi AJ, Alotaibi AM, Alnakhli FS, Almuhalbidi SA, Almutawa KM, Aljohani AS. POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis. IJMDC. 2025; 9(12): 3376-3386. doi:10.24911/IJMDC.51-1765562673


Vancouver/ICMJE Style

Awaji HH, Ajaj AA, Awkar LA, Sharif MA, Alrashidi AJ, Alotaibi AM, Alnakhli FS, Almuhalbidi SA, Almutawa KM, Aljohani AS. POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis. IJMDC. (2025), [cited January 16, 2026]; 9(12): 3376-3386. doi:10.24911/IJMDC.51-1765562673


Harvard Style

Awaji, H. H., Ajaj, . A. A., Awkar, . L. A., Sharif, . M. A., Alrashidi, . A. J., Alotaibi, . A. M., Alnakhli, . F. S., Almuhalbidi, . S. A., Almutawa, . K. M. & Aljohani, . A. S. (2025) POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis. IJMDC, 9 (12), 3376-3386. doi:10.24911/IJMDC.51-1765562673


Turabian Style

Awaji, Hosam Hadi, Abdulkareem Abdulrahman Ajaj, Lujain Ali Awkar, Murad Ali Sharif, Ahmed Jarallah Alrashidi, Abdullah Mastour Alotaibi, Fawzeyah Suliman Alnakhli, Safiyah Abdullah Almuhalbidi, Khalid Mohammed Almutawa, and Abdulaziz Saad Aljohani. 2025. POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, 9 (12), 3376-3386. doi:10.24911/IJMDC.51-1765562673


Chicago Style

Awaji, Hosam Hadi, Abdulkareem Abdulrahman Ajaj, Lujain Ali Awkar, Murad Ali Sharif, Ahmed Jarallah Alrashidi, Abdullah Mastour Alotaibi, Fawzeyah Suliman Alnakhli, Safiyah Abdullah Almuhalbidi, Khalid Mohammed Almutawa, and Abdulaziz Saad Aljohani. "POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries 9 (2025), 3376-3386. doi:10.24911/IJMDC.51-1765562673


MLA (The Modern Language Association) Style

Awaji, Hosam Hadi, Abdulkareem Abdulrahman Ajaj, Lujain Ali Awkar, Murad Ali Sharif, Ahmed Jarallah Alrashidi, Abdullah Mastour Alotaibi, Fawzeyah Suliman Alnakhli, Safiyah Abdullah Almuhalbidi, Khalid Mohammed Almutawa, and Abdulaziz Saad Aljohani. "POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries 9.12 (2025), 3376-3386. Print. doi:10.24911/IJMDC.51-1765562673


APA (American Psychological Association) Style

Awaji, H. H., Ajaj, . A. A., Awkar, . L. A., Sharif, . M. A., Alrashidi, . A. J., Alotaibi, . A. M., Alnakhli, . F. S., Almuhalbidi, . S. A., Almutawa, . K. M. & Aljohani, . A. S. (2025) POTTER versus ACS-SRC – revolutionizing emergency surgery with AI: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, 9 (12), 3376-3386. doi:10.24911/IJMDC.51-1765562673




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