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M A Gok, M Bughio, N O M Mathieson, M Zaidi, M M Sadat, U A Khan, WP5.13 - National Emergency Laparotomy (NELA) critical care admissions: A cohort study, British Journal of Surgery, Volume 111, Issue Supplement_8, September 2024, znae197.175, https://doi.org/10.1093/bjs/znae197.175
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Abstract
NELA is committed to enhancing quality of peri-operative care of patients undergoing emergency laparotomy. NELA emphasizes importance of identifying high risk patients, who are associated with significant morbidity & mortality. Critical care allows close monitoring, organ (basic/advanced) support. Aim of study is to review the NELA critical care patients.
Cohort study of NELA patients that received post-operative ITU care (direct/indirect admission) at single centre. Descriptive demography, and outcomes were evaluated. NELA parsimonious risk & CCMDS ITU scores used. NELA patient that did not require ITU care were controls.
| NELA critical care (n = 400) . | NELA non critical care (n = 466) . | Mann Whitney U (p value) . | Deaths (n) - (n) . |
|---|---|---|---|
| Age(yrs) | 71.8 | 64.0 | < 0.0001 |
| Sex(M:F) | 173 : 227 | 220 : 246 | NS |
| ASA | 3 | 2 | < 0.0001 |
| BMI(kg/m2) | 26.3 | 25.0 | NS |
| Lap(n) | 67 | 168 | |
| Open(n) | 333 | 293 | |
| Op time(mins) | 131.0 | 109.4 | < 0.0001 |
| LOS(days) | 18 | 9.5 | < 0.0001 |
| Deaths | |||
| 30 day | 50 | 25 | |
| 60 day | 66 | 37 | |
| 90 day | 73 | 40 | |
| Lactate(mmol/L) | 2.4 | 1.8 | <0.01 |
| WCC(x109/L) | 13.0 | 11.8 | <0.05 |
| CRP(mg/L) | 90.1 | 56.6 | <0.0001 |
| Physiological-score | 25.6 | 19.8 | <0.0001 |
| Operative-severity-score | 17.9 | 15.9 | <0.0001 |
| Prepossum-score | 21.6 | 7.5 | <0.0001 |
| PPmortality-score | 11.9 | 4.9 | <0.0001 |
| PPmorbidity-score | 77.3 | 55.7 | <0.0001 |
| Survival Rate (%) | |||
| 1styear | 75.4 | 86.2 | |
| 5thyear | 53.8 | 70.8 | Logrank |
| 10thyear | 41.1 | 58.7 | p<0.0001 |
| NELA critical care (n = 400) . | NELA non critical care (n = 466) . | Mann Whitney U (p value) . | Deaths (n) - (n) . |
|---|---|---|---|
| Age(yrs) | 71.8 | 64.0 | < 0.0001 |
| Sex(M:F) | 173 : 227 | 220 : 246 | NS |
| ASA | 3 | 2 | < 0.0001 |
| BMI(kg/m2) | 26.3 | 25.0 | NS |
| Lap(n) | 67 | 168 | |
| Open(n) | 333 | 293 | |
| Op time(mins) | 131.0 | 109.4 | < 0.0001 |
| LOS(days) | 18 | 9.5 | < 0.0001 |
| Deaths | |||
| 30 day | 50 | 25 | |
| 60 day | 66 | 37 | |
| 90 day | 73 | 40 | |
| Lactate(mmol/L) | 2.4 | 1.8 | <0.01 |
| WCC(x109/L) | 13.0 | 11.8 | <0.05 |
| CRP(mg/L) | 90.1 | 56.6 | <0.0001 |
| Physiological-score | 25.6 | 19.8 | <0.0001 |
| Operative-severity-score | 17.9 | 15.9 | <0.0001 |
| Prepossum-score | 21.6 | 7.5 | <0.0001 |
| PPmortality-score | 11.9 | 4.9 | <0.0001 |
| PPmorbidity-score | 77.3 | 55.7 | <0.0001 |
| Survival Rate (%) | |||
| 1styear | 75.4 | 86.2 | |
| 5thyear | 53.8 | 70.8 | Logrank |
| 10thyear | 41.1 | 58.7 | p<0.0001 |
| NELA critical care (n = 400) . | NELA non critical care (n = 466) . | Mann Whitney U (p value) . | Deaths (n) - (n) . |
|---|---|---|---|
| Age(yrs) | 71.8 | 64.0 | < 0.0001 |
| Sex(M:F) | 173 : 227 | 220 : 246 | NS |
| ASA | 3 | 2 | < 0.0001 |
| BMI(kg/m2) | 26.3 | 25.0 | NS |
| Lap(n) | 67 | 168 | |
| Open(n) | 333 | 293 | |
| Op time(mins) | 131.0 | 109.4 | < 0.0001 |
| LOS(days) | 18 | 9.5 | < 0.0001 |
| Deaths | |||
| 30 day | 50 | 25 | |
| 60 day | 66 | 37 | |
| 90 day | 73 | 40 | |
| Lactate(mmol/L) | 2.4 | 1.8 | <0.01 |
| WCC(x109/L) | 13.0 | 11.8 | <0.05 |
| CRP(mg/L) | 90.1 | 56.6 | <0.0001 |
| Physiological-score | 25.6 | 19.8 | <0.0001 |
| Operative-severity-score | 17.9 | 15.9 | <0.0001 |
| Prepossum-score | 21.6 | 7.5 | <0.0001 |
| PPmortality-score | 11.9 | 4.9 | <0.0001 |
| PPmorbidity-score | 77.3 | 55.7 | <0.0001 |
| Survival Rate (%) | |||
| 1styear | 75.4 | 86.2 | |
| 5thyear | 53.8 | 70.8 | Logrank |
| 10thyear | 41.1 | 58.7 | p<0.0001 |
| NELA critical care (n = 400) . | NELA non critical care (n = 466) . | Mann Whitney U (p value) . | Deaths (n) - (n) . |
|---|---|---|---|
| Age(yrs) | 71.8 | 64.0 | < 0.0001 |
| Sex(M:F) | 173 : 227 | 220 : 246 | NS |
| ASA | 3 | 2 | < 0.0001 |
| BMI(kg/m2) | 26.3 | 25.0 | NS |
| Lap(n) | 67 | 168 | |
| Open(n) | 333 | 293 | |
| Op time(mins) | 131.0 | 109.4 | < 0.0001 |
| LOS(days) | 18 | 9.5 | < 0.0001 |
| Deaths | |||
| 30 day | 50 | 25 | |
| 60 day | 66 | 37 | |
| 90 day | 73 | 40 | |
| Lactate(mmol/L) | 2.4 | 1.8 | <0.01 |
| WCC(x109/L) | 13.0 | 11.8 | <0.05 |
| CRP(mg/L) | 90.1 | 56.6 | <0.0001 |
| Physiological-score | 25.6 | 19.8 | <0.0001 |
| Operative-severity-score | 17.9 | 15.9 | <0.0001 |
| Prepossum-score | 21.6 | 7.5 | <0.0001 |
| PPmortality-score | 11.9 | 4.9 | <0.0001 |
| PPmorbidity-score | 77.3 | 55.7 | <0.0001 |
| Survival Rate (%) | |||
| 1styear | 75.4 | 86.2 | |
| 5thyear | 53.8 | 70.8 | Logrank |
| 10thyear | 41.1 | 58.7 | p<0.0001 |
NELA critical care patients had poorer survival rates in our study. Theatre return or indirect critical care transfers can adversely affect survival. These patients were older, frail, multiple co-morbid status. NELA parsimonious mortality risk score >5% should encourage consultant level supervision, mortality risk score >10% should encourage direct critical care involvement.
