TPW 4.15 Impact of ITU Care on NELA Patients: A Cohort Study with INARC (Intensive Care National Audit Centre) Scores

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: National Emergency Laparotomy Audit (NELA) patients (n=1074). Intervention: Indirect ITU admission vs. Direct ITU admission or non-ITU care. Primary outcome: 1st-year survival rate (p=<0.0001).

Q: What does this research mean for the field?

Indirect intensive care admission following emergency laparotomy is associated with significantly higher morbidity, longer hospital stays, and reduced long-term survival compared to direct intensive care admission. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

M A Gok; K Riaz; S Khan; R U Aris; C L Hughes; U A Khan

doi:10.1093/bjs/znag087.341

August 1, 2026British journal of surgeryOpen Access

TPW 4.15 Impact of ITU Care on NELA Patients: A Cohort Study with INARC (Intensive Care National Audit Centre) Scores

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Why the study?

The impact of post-operative ITU care on outcomes and survival in NELA patients was unclear, particularly comparing direct versus indirect ITU transfers.

Does direct versus indirect post-operative ITU admission impact survival and outcomes in NELA patients?

Key Points

To assess the clinical outcomes, risk profile, and long-term survival of emergency laparotomy patients receiving direct versus indirect postoperative intensive therapy unit admission compared to non-admitted controls.
Single-center cohort study of emergency laparotomy patients treated between January 2014 and January 2026 (N=1,074).
Patients were categorized into direct ITU admission (n=445), indirect/delayed ITU admission (n=40), and non-ITU controls (n=589).
Baseline physiology, risk scores (NELA, ICNARC, APACHE-II, P-POSSUM), hospital length of stay, and survival up to 10 years were analyzed.
Ninety-day mortality was significantly higher in indirect ITU patients (16/40 [40.0%]) compared to direct ITU patients (74/445 [16.6%]) and non-ITU controls (41/589 [7.0%]; p<0.0001).
Indirect ITU transfer was associated with prolonged total hospital length of stay (25±16.5 vs. 17±10 vs. 9±5 days, p<0.0001) and extended ITU duration (8±7.5 vs. 3±1.5 days, p<0.0001).
Survival rates were consistently lowest in the indirect ITU cohort at 1 year (57.3% vs. 75.6% vs. 88.6%), 5 years (30.1% vs. 52.9% vs. 73.9%), and 10 years (25.8% vs. 35.6% vs. 64.9%; Log-rank p<0.0001).

Study Design

Type

Cohort (n=1,074)

Multicenter

No

Structured PICO

Does direct versus indirect post-operative ITU admission impact survival and outcomes in NELA patients?

P

Population

1,074 NELA patients (445 direct ITU, 40 indirect ITU, and 589 non-ITU controls) treated between January 2014 and January 2026 at a single institution.

E

Exposure

Post-operative Intensive Therapy Unit (ITU) care, categorized as direct ITU admission (n=445) or indirect ITU admission (n=40).

C

Comparator

NELA patients not requiring ITU care (n=589).

O

Outcome

Survival rates at 1, 5, and 10 years, and 90-day mortality.hard clinical

Main Result

Absolute Event Rate: 57.3% vs 88.6%

p-value: p=<0.0001

Implication

Direct post-operative ITU admission is associated with significantly better survival outcomes compared to indirect ITU admission in NELA patients.

Abstract

Aims NELA is a national-clinical-audit (focusses-on-systematic NELA-care-pathways). ITU-enables close-monitoring & organ-support, accounting 77.6% of NELA-cases (NELA-2025). Aim-of-study-is-review NELA-patients that-received post-operate-ITU-care (direct & indirect-ITU-transfers). Methods Cohort study of NELA-patients-that-received-post-operative-ITU-care: Jan’2014-to-Jan’2026 at single-institution. NELA-parsimonious-risk & INARC-scores used. NELA-patients not-requiring ITU-care were-controls. Results Direct-ITU(n=445) Indirect-ITU(n=40) NELA-non -ITU(n=589) Kruskall-Wallis (p-value)ANOVA Age(yrs) 71.4±0.7 65.2±2.8 64.9±0.7 <0.0001 Sex(M:F) 196:249 18:22 290:299 NS ASA 3±0.5 3±0.5 2±0.5 <0.0001 BMI(kg/m2) 26.4±0.4 28.1±1.2 25.2±0.3 <0.01 RCS-category-1 (n) 208 23 178 < 0.0001 RCS-category 2-(n) 237 17 411 < 0.0001 Op-time(mins) 134.9±3.0 150.2±11.5 113.7±2.8 <0.0001 LOS(days) 17±10 25±16.5 9 ±5 <0.0001 90-D-mortality(n) 74 16 41 <0.0001 ITU-stay(days) 3±1.5 8±7.5 Mann-Whitney-U<0.0001 APACHE-II 13.2±0.3 15.8±1.2 <0.005 INARC-score(%) 13.8±0.6 20.0±1.9 <0.0005 INARC-mortality (%) 14.6±0.6 26.2±2.6 <0.0001 Lactate(mmol/L) 2.2±0.1 2.3±0.4 1.8±0.1 <0.05 WCC(x109/L) 12.9±0.3 14.5±1.0 11.7±0.2 <0.001 CRP(mg/L) 100.1±5.9 124.2±16.7 57.1±3.4 <0.0001 Phy-SS-score 25.4±0.4 31.4±2.0 19.9±0.3 <0.0001 Op-score 18.1±0.3 19.6±1.0 15.9±0.2 <0.0001 PP-score 21.0±1.5 39.1±8.9 7.2±0.7 <0.0001 NELA-mort-score 15.1±0.8 26.9±4.8 5.4±0.4 <0.0001 PP-morb-score 77.3±1.4 83.3±4.7 55.5±1.6 <0.0001 Survival-Rate(%) 1st-year 75.6 57.3 88.6 Logrank(p<0.0001) 5th-year 52.9 30.1 73.9 10th-year 35.6 25.8 64.9 Conclusion NELA indirect-ITU-patients had poorer-outcome-measures & survival-rates in-study. NELA-mortality-risk-scores >5% should-encourage-consultant-care, mortality-risk-score >10% should-encourage-direct-ITU-admission-post-operatively. There is added benefit of direct-ITU-admission, reducing indirect-ITU-admissions (increased-morbidity &-mortality).

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Cite This Study

Gok et al. (2026) conducted a cohort in National Emergency Laparotomy Audit (NELA) patients (n=1,074). Indirect ITU admission vs. Direct ITU admission or non-ITU care was evaluated on 1st-year survival rate (p=<0.0001).

synapsesocial.com/papers/6ad0fc7415427f6a840400fc https://doi.org/10.1093/bjs/znag087.341

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TPW 4.15 Impact of ITU Care on NELA Patients: A Cohort Study with INARC (Intensive Care National Audit Centre) Scores

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

TPW 4.15 Impact of ITU Care on NELA Patients: A Cohort Study with INARC (Intensive Care National Audit Centre) Scores

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

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