895 A Retrospective Analysis of National Emergency Laparotomy Audit (NELA) Data at a Tertiary Hospital

Aim

To audit emergency laparotomy outcomes in a tertiary hospital and identify areas for improvement.

Method

Retrospective analysis of 148 cases from Year 8 (12/2020-11/2021) of NELA patient data. Categorical and continuous data were analysed through chi-squared and t-tests, using R (version:4.2.2).

Results

Our NELA patient length-of-stay (LOS) was 2.2x the national mean (33.59 vs.15.1 days). 14 statistical outliers in LOS were identified which compounded the discrepancy between our median (15 days) and mean (33.59 days). Patients with stomas formed had a significantly higher mean LOS compared to those without (42 vs 26 days). Frail patients did not have a higher LOS, and much higher mean rates of review by geriatricians was noted (87% vs. 24% nationally).

A greater percentage of our patients had high pre-operative mortality risk scores compared to nationally (51.5% vs. 43.5%). A higher percentage of our patients had ischaemia (20.8% vs. 8.9%) and haemorrhage (5.6% vs. 2.6%) as indications for surgery. However, our 30-day mortality rate was lower on average (5.5% vs. 9.7%).

Conclusions

Our hospital's high rates of complicated cases and low mortality rates suggest a high-quality of patient care. Length of stay has been identified as an area for improvement, and we propose implementation of special discussion of long-staying patients in weekly ward round meetings as a potential intervention. While there may be various factors contributing to our higher mean LOS, we postulate that our status as a major stoma centre and tertiary referral centre for complicated cases as likely the primary cause.