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M A Gok, M Bughio, M Zaidi, N O M Mathieson, M M Sadat, U A Khan, Komal Riaz, WP3.15 - National Emergency Laparotomy (NELA) deaths within 90 days: A cohort study, British Journal of Surgery, Volume 111, Issue Supplement_8, September 2024, znae197.148, https://doi.org/10.1093/bjs/znae197.148
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Abstract
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.
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.
| . | 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 |
| . | 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 |
| . | 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 |
| . | 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 |
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.
- body mass index procedure
- care of intensive care unit patient
- comorbidity
- consultants
- critical pathways
- demography
- frail elderly
- intensive care unit
- lactates
- laparotomy
- perioperative care
- resuscitation
- surgical procedures, operative
- survival rate
- survivors
- diagnosis
- morbidity
- mortality
- quality improvement
- intensivist
- asa status 3
- anesthetists
