eP10 Decision Making For and Against Emergency Laparotomy in High Risk Patients: A Prospective Trust-Wide Study
Rebecca Bradley, Amritha Priya Krishna, Chloe Blatchford, Hamza Mohamed, Ionnais NikolopoulosAbstract
Intro
High Risk emergency laparotomy patients are characterised as having a NELA score >5%, but this often underestimates risk. Many factors influence the decision for laparotomy in these patients. Outcomes for patients who do not proceed to laparotomy are less reported in literature.
Aims
The primary aim was to compare outcomes in high risk patients (NELA >5%) who were managed with a laparotomy (Lap), vs those who were managed non-operatively (NoLap). Our secondary aim was to explore the decision making process to investigate which factors influenced the decision for a laparotomy vs non-operative management
Methods
A prospective study over 6 months was conducted across two hospitals. Patients with NELA >5% and aged 65 or over warranting laparotomy were included. Fisher's and Mann-Whitney U testing was used to compare Lap and NoLap outcomes. Multivariable regression analysis was used to determine which factors were most relied upon to make the decision for or against laparotomy.
Results
A total of 62 patients were included. NoLap patients had significantly higher NELA(p=<0.001), ASA (p=0.008), Clinical Frailty (p=<0.001) scores, but higher mortalities (<0.001). Only 32% of all cases had a full MDT involved in decision for/against laparotomy. Clinical Frailty Score was the most specific and sensitive factor influencing decision for a laparotomy (p=<0.001).
Conclusions
High risk NoLap patients have worse outcomes than their Lap counterparts. Although Clinical Frailty Score is not currently included in the NELA calculation, it is a crucial variable in influencing decision making for laparotomy in high risk patients.