Background: Preoperative risk assessment and perioperative factors may help identify patients at increased risk of postoperative complications and allow postoperative management strategies that improve patient outcomes. Aim and objective: To be a be a reliable preoperative prognosticator for postoperative complications of surgery. Method: A prospective observational study was conducted among eligible adult patients undergoing laparotomies at SJ MCH, Puri Hospital, and followed up for 3 months. We collected data on the patient’s preoperative and intraoperative characteristics. Using the data generated, SAS was calculated, and patients were classified into 3 groups, namely: low (8–10), medium (5–7), and high (0–4). The primary outcomes were in-hospital major complications and mortality. Data was presented as proportions, mean (standard deviation), or median (interquartile range), as appropriate. We used inferential statistics to determine the association between the SAS and the primary outcomes, while the SAS discriminatory ability was determined from the receiver-operating curve (ROC) analysis. Results: Of the 100 participants recruited, 68 (68%) were male, and the mean age was 40.6±15. Overall postoperative in-hospital major complications and mortality rates were 24% and 10%, respectively. The participants with a high SAS category had an 18-times risk (95% CI, 2–95, p = 0.012) of developing major complications, while those in the medium SAS category had a 3-times risk (95% CI, 1–15, p = 0.0452) of dying. SAS had a fair discriminatory ability for in-hospital major complications and mortality with an area under the curve of 1 and 1, respectively. The sensitivity and specificity of SAS≤6 for major complications were 60% and 8%, respectively, and for death, 54% and 81%, respectively. Conclusion: SAS of≤6 is associated with an increased risk of major complications and/or mortality. SAS has a high specificity and an overall fair discriminatory ability to predict the risk of developing in-hospital major complications and/or death following laparotomy.