TPW 9.15 National Emergency Laparotomy (NELA) Deaths Within 90 Days: A Cohort Study with INARC Scores (Intensive Care National Audit Research Centre)

Abstract

There has-been a-reduction in 30-day-mortality: 11% to 8.1 % (NELA report 2025). NELA has-set care-pathways-in-management-of-emergency-laparotomies. Aim of study is to assess-outcomes of emergency-laparotomy amongst-the-90-day-deaths. Cohort-study of NELA-deaths within-90-days, from Jan’2014 to Jan’2026 at single institution. Descriptive-demography & surgical-outcomes were analysed. NELA survivors beyond >90 days were controls. < 90-day(n=130) >90-day(n=930) Mann-Whitney-U(p-value) Age (yrs) 74.5±1.1 66.8±0.5 <0.0001 Sex(M:F) 64:66 423:507 NS ASA 3±1 3±1 <0.0001 BMI(kg/m2) 26.7±0.7 25.7 ± 0.2 NS RCS-category(n) 2 2 NS Lap(n) 22 312 0.0112 30-D-deaths 86 60-D-deaths 119 90-D-deaths 130 ITU(n) 89 398 <0.0001 Direct 73 374 <0.0001 Indirect 16 24 <0.0001 APCHES-II 16.1±0.7 12.8±0.3 <0.0001 INARC-mortality(%) 22.5±1.9 12.0±0.5 <0.0001 Hosp Mortality(%) 23.6±1.9 13.7±0.5 <0.0001 Con-surg(n) 129 899 NS Con-anae(n) 118 716 NS Op-time(mins) 124.8±5.5 124.3±2.2 NS LOS(days)(med±IQR) 17±5.5 12±7.5 NS Lactate(mmol/L) 2.9± .3 1.9±0.1 <0.0001 WCC(x109/L) 13.1±0.6 12.2±0.2 NS CRP(mg/L) 101.8±10.5 74.4±3.4 0.0011 Physiological-score 28.2±0.8 21.7±0.3 <0.0001 Operative-severity-score 19.9±0.5 16.4±0.2 <0.0001 Pre-possum score 29.4±3.3 11.9±0.8 <0.0001 PP-mortality-score 25.9±1.9 8.1±0.4 <0.0001 PP-morbidity-score 82.4±2.1 63.5±1.3 <0.0001 Survival-Rate(%) 1st year 82.0 5th year 63.2 10th year 49.9 At our-centre, crude-NELA 30-day & 90-day mortality-rates-were 8.1 % & 12.3 % respectively. Key predictors of mortality-include: age, frailty, physiological status, comorbidities & underlying surgical-conditions & surgical-urgency. Factors-improving survival-include: early-diagnosis & intervention(timeliness), consultant-led-care, specialized-units (peri-operative ITU-care), early-geriatric-review.