SP2.04 Prognostic Significance of Socioeconomic Deprivation in Patients Undergoing Emergency Laparotomy: A Retrospective Cohort Study

Aims Deprivation is a complex, multifaceted concept and not synonymous with poverty. The aim of this study was to assess the prognostic influence of multiple deprivation index on Emergency Laparotomy (EL) outcome. Methods STROCSS statement standards were followed to conduct a retrospective cohort study. Consecutive 1,723 adult patients [median age (range): 66 (18-98), 762 M, 961 F] undergoing EL over eight years (2014-22) at two hospitals [a Tertiary Teaching Centre and District General Hospital (DGH)] were studied. Deprivation scores and ranks were derived from patients’ postcodes, using the Welsh Index of Multiple Deprivation and ranks categorised into quartiles. Primary outcome measure was 30-day Operative Mortality (OM). Results OM risk was higher in the most deprived Quartile (Q1) compared with the least deprived Quartile (Q4) (13.2% vs 7.9%, p=0.008). Deprivation was an independent predictor of OM on both univariate (unadjusted OR: 1.75, 95% CI 1.17-2.61, p=0.006) and multivariable logistic regression analyses (OR: 1.03, 95% CI 1.01-1.06, p=0.023; adjusted for age ≥ 80 years, ASA grade, need for bowel resection, and peritoneal contamination). Deprivation had poor discriminatory value in predicting OM (AUC: 0.56, 95% CI 0.54-0.59). Subgroup analysis showed that although the risk of OM was lower in the Tertiary Centre compared with the DGH (7.9% vs. 14.5%, p<0.001) the predictive significance of deprivation was similar in both hospitals (AUC: 0.54 vs 0.56, p= 0.674). Conclusion Deprivation is an independent but modest predictor of OM after EL. The potential prognostic value of incorporating deprivation into preoperative risk assessment algorithms deserves further evaluation.