WP3.15 - National Emergency Laparotomy (NELA) deaths within 90 days: A cohort study

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Abstract Aims NELA is committed to enhancing quality of care of patients undergoing emergency laparotomy. NELA care pathways include: initial clinical assessment, resuscitation, prompt diagnosis, early surgery, peri-operative care. NELA emphasizes the importance of identifying high risk patients, who are associated with significant morbidity & mortality. Aim of study is to review the NELA 90-day deaths. Methods Cohort study of NELA deaths within 90 days, from Jan'2014 to Jan'2024 at single centre. Descriptive demography, outcomes were evaluated. NELA survivors beyond 90 days were controls. Results 90 Day (n = 113) Others (n = 751) Mann Whitney U (p value) Age(yrs) 74.3 66.6 < 0.0001 Sex(M:F) 58 : 55 334 : 417 NS ASA 3 2 < 0.0001 BMI(kg/m2) 25.1 25.7 NS Lap(n) 16 218 Ns Open(n) 97 533 < 0.01 Op time(mins) 120.2 119.1 NS LOS(days) 17 12 NS ITU/HDU 70 318 < 0.001 ITU stay(day) 3 2 < 0.05 Lactate(mmol/L) 3.0 1.9 0.0002 WCC(x109/L) 13.2 12.3 NS CRP(mg/L) 93.6 68.8 < 0.0001 Physiological score 28.2 21.6 < 0.0001 Operative severity score 20.0 16.4 < 0.0001 Pre possum score 29.4 11.9 < 0.0001 PP mortality score 23.4 6.1 < 0.0001 PP morbidity score 82.9 63.5 < 0.0001 Survival Rate (%) 1styear 81.4 5thyear 63.0 10thyear 50.7 Conclusion 90-day NELA mortality rate is 13.1 %. NELA deaths occurred in older, frail, multi-comorbid & higher ASA status Patient survival appears to plateau out beyond 90-days (natural deaths). NELA risk scores were greater amongst the 90-day deaths. NELA risk scores can identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetist and intensivists may identify and allocate appropriate surgical & critical care intervention.

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