EP 667 Royal College of Surgeons (RCS) Category 1 Versus Category 2 NELA: A Cohort Study on INARC (Intensive-Care-National-Audit & Research Centre) Scores
M A Gok, K Riaz, S Khan, R U Aris, C L Hughes, U A KhanAbstract
Aims
NELA is national-clinical-audit that focusses on-systematic-NELA care-pathways. NELA-has-adopted Royal-College-of-Surgeons (RCS) categorization (diagnostic & surgical-urgency): RCS-1 (immediate-organ/life-threatening) & RCS-2 (non-immediate-potential-threat-to-organ/life) (NELA-2025). Aim-of-study: assess-outcomes in RCS-1 & RCS-2 NELA cases.
Methods
Cohort-study carried-out-on RCS-1 &-2 NELA-patients: Jan’2014-to-Jan’2026 at single-institution. Descriptive-demography, NELA-parsimonious-risk-scores, INARC-scores serological-biomarkers (WCC & CRP) were-analysed.
Results
RCS-1(n=415) RCS-2(n=634) Mann-Whitney-U(p-value) Age(yrs) 65.2±0.9 69.3±0.6 NS Sex(M:F) 184:231 289:345 NS ASA 3±1 3±1 NS BMI(kg/m2) 26.4±0.4 25.5±0.3 NS Con-Anaes(n) 334 506 NS Con-Surg(n) 410 622 NS Op-time(mins) 132.9±3.3 119.1±2.6 0.001 LOS(days) 13±8.5 12±7.5 NS 90-D-mortality(n) 61 69 NS ITU-direct(n) 162 236 NS ITU-indirect(n) 18 17 NS ITU(n) 180 253 NS ITU-stay(days) 3±2 2±1.5 NS APACHE-II 13.9±0.4 13.0±0.3 NS INARC-score(%) 14.9±0.9 13.6±0.7 NS INARC-mortality (%) 16.2±0.9 14.9±0.7 NS Lactate(mmol/L) 2.3±0.1 1.9±0.1 <0.0001 WCC(x109/L) 12.67±0.3 12.1±0.2 <0.05 CRP(mg/L) 104.6±6.0 60.4±3.5 <0.0001 Phy-SS-score 23.7±0.5 22.1±0.3 0.0120 Op-score 19.5±0.4 15.9±0.2 <0.0001 PP-score 26.6±2.2 11.6±0.9 <0.0001 NELA-mort-score 12.3±0.9 9.0±0.5 <0.05 PP-morb-score 75.0±2.0 62.9±1.4 <0.0001 Survival Rate(%) 1st-year 81.0 82.1 Logrank(p =NS) 5th-year 66.3 61.1 10th-year 51.4 47.9
Conclusion
RCS-1 NELA patients had worse pre-operative NELA markers, but clinical-outcomes were identical. Study demonstrates-importance-of-timelines-of-diagnosis & intervention: if RCS-1 cases-receive-earlier-intervention (diagnosis,-surgery,-antibiotics,-consultant-level-care,-ITU-cares), they-can-achieve-same-outcomes as RCS-2. RCS-1 cases-usually-unstable (active resuscitation) whilst-surgical- intervention is-carried-out. RCS-2 cases-are-optimized-prior-to-surgery.