ThP7.18 - Post-operative management and outcomes in emergency laparotomy - an audit of the updated 2023 NELA Standards in a busy district general hospital

Background The updated NELA Standards, encourage pre-operative decision-making, were published and utilised from April 2023. Our busy district general hospital has not been audited against these updated standards. Methods Single-centre, retrospective audit of emergency laparotomies between April 2023 and December 2023. Patients were included if the NELA risk score was ≥5% (‘high-risk’) or if they were deemed ‘high-risk’ based on clinical judgement. Demographic, management, and outcome data were collected from the local NELA database and EPR. The primary outcome was the proportion of ‘high-risk’ patients directly admitted to critical care. The secondary outcome was to investigate differences between high-risk patients admitted to critical care and those admitted to ward care using length of stay (LOS) and 30-day observed/expected (O/E) mortality ratio. Results 112 laparotomies were performed and 43 (38%) were deemed ‘high-risk’. Of ‘high-risk’ patients, the median age was 73 (44 - 95), 56% were male, and the median mortality risk was 10.5% (3.1% – 62.7%). 38 ‘high-risk’ patients were directly admitted to critical care. They had a median LOS of 14 days (3 – 72) and 7 died within 30 days with an O/E mortality ratio of 1.12. None of the 5 patients admitted directly to the ward died and they had a median LOS of 8 days (3 – 39). Conclusion The mortality risk score is a tool for post-operative management in emergency laparotomy but appropriate clinical judgement can prevent excessive care and preserve critical care beds.