MTP2.14 Emergency Laparotomy ITU admissions: A cohort study

Aims Emergency laparotomy is associated with significant morbidity & mortality. NELA has set care-pathways in management of emergency laparotomy. ITU-care offers close observation, organ support & early diagnosis of complications, but beds are limited with restricted admission-criteria. Aim of study is to assess outcomes of NELA laparotomy patients treated in the ITU peri-operatively. Methods Cohort study of emergency laparotomy NELA-patients that went to ITU from Jan'2014 to Jan'2025 at a single centre. NELA-parsimonious & ICNARC scores were used. NELA-laparotomy patients not requiring ITU care were recruited as controls. Results NELA-ITU(n=352) NELA-non-ITU(n = 588) Mann-Whitney-U(p-value) Age(yrs) 71.2±0.8 65.8±0.7 <0.0001 Sex(M:F) 156:196 277:311 NS ASA 3 2 <0.0001 BMI (kg/m2) 26.3±0.4 25.2±0.3 NS Lap(n) 81 197 <0.01 Op-time(mins) 138.1±3.3 112.4±2.3 <0.0001 Indirect-ITU-transfer(n) 29 Direct-ITU-transfer(n) 323 ITU-stay(days) 3±2 LOS (days) 18±10 10±6 <0.0001 90-D(n) 70 49 < 0.01 Lactate(mmol/L) 2.4±0.1 1.8±0.1 <0.001 WCC (x109/L) 13.2±0.4 11.9±0.2 0.0045 CRP (mg/L) 99.7±6.5 63.4±3.7 <0.0001 Physiological-score 25.7±0.5 20.9±0.3 <0.0001 Operative-severity-score 18.4±0.3 16.1±0.2 <0.0001 Pre-possum-score 24.1±1.9 9.5±0.8 <0.0001 PP-mortality-score 12.1±0.9 5.5±0.5 <0.0001 PP-morbidity-score 78.5±1.6 60.1±1.4 <0.0001 Survival Rate (%)1styear5thyear10thyear 73.752.234.6 85.467.254.3 Logrankp<0.0001 Conclusion NELA-ITU-patients were identified with higher NELA parsimonious-scores, with poorer survival rates in our study. ITU readmissions (indirect-ITU transfers) can adversely affect survival. NELA ITU patients were more unwell and high risk individuals (older, restricted disease ASA 3). Post-operative ITU support should be offered to all NELA laparotomy patients.