Introduction: Emergency laparotomies encompass a broad spectrum of urgent surgical procedures, often associated with significant mortality and morbidity. These procedures, performed in response to both traumatic and non-traumatic events, are particularly critical due to their time-sensitive nature. Despite the advancements in surgical care, the mortality rate for emergency laparotomies remains substantially higher compared to elective surgeries, with global disparities in surgical outcomes, particularly in low-income countries. Current tools for risk assessment, such as the ACS-NSQIP, fall short in accurately predicting outcomes for patients undergoing emergency general surgery (EGS), leading to the development of the Emergency Surgery Score (ESS) as a more tailored predictive scoring. Background: The Emergency Surgical Score (ESS) was introduced in 2016 as a risk assessment tool designed for patients undergoing Emergency abdominal surgery. It has since been validated as a predictor of not only 30-day mortality but also complications happening in the postoperative period and the need for high-dependency intensive care. Data Analysis: This study involved 131 patients who underwent emergency laparotomies at B.L.D.E.(D.U)’s Shri B.M.Patil Medical College Hospital and Research Centre, Vijayapura, between August 2022 and June 2024. Patients were assessed using the ESS, and their postoperative outcomes were categorised as fair, ICU admission required, or mortality. The analysis focused on demographic variables, comorbidities, presenting illnesses, and laboratory findings, comparing these factors with the ESS and postoperative outcomes. Results: The study population comprised 35 females and 96 males, with a higher ESS score correlating with increased age and male sex. Patients with an ESS score above 15 had significantly higher mortality rates, especially those over 60 years. The ESS effectively predicted outcomes, with higher scores indicating a need for more intensive postoperative care and a higher likelihood of mortality. The ESS’s predictive ability was evident across various patient characteristics and comorbidities, highlighting its utility in clinical settings. Discussion: The ESS has proven to be a valuable tool in predicting postoperative outcomes in emergency laparotomy patients. Its ability to stratify patients by risk allows for better resource allocation, informed patient counselling, and potentially improved postoperative care. The correlation between higher ESS scores and adverse outcomes underscores the importance of this tool in managing high-risk surgical patients. This study reaffirms the ESS's role in guiding clinical decisions, particularly in resource-constrained settings where surgical outcomes may be poorer. Conclusion: The ESS is an accurate predictor of morbidity and mortality in patients undergoing emergency laparotomy. Its use can significantly enhance the preoperative assessment process, leading to better patient outcomes through targeted interventions and appropriate resource allocation. As surgical care continues to evolve, the ESS stands out as a critical tool in managing the complexities of emergency general surgery.