eP37 NO-LAP - A New Expansion within NELA

Abstract

The National Emergency Laparotomy Audit (NELA), launched in 2013, has markedly improved outcomes for emergency abdominal surgeries in England and Wales by implementing systematic reviews, preoperative risk assessments, and geriatric evaluations. This approach has resulted in reduced 30-day mortality rates and shorter hospital stays for around 22,000 annual laparotomies.

In its latest expansion, NELA now includes the NO-LAP cohort—patients with acute abdominal conditions who do not undergo surgery. This group faces high mortality rates (63%-95%) due to advanced age, comorbidities, and frailty. The inclusion of NO-LAP aims to fill critical gaps in understanding and managing these high-risk patients.

The addition of the NO-LAP cohort will provide valuable insights into the factors influencing the decision not to operate and enhance understanding of non-surgical management strategies. This will inform new quality improvement initiatives and offer a clearer picture of patient outcomes in this vulnerable group.

This expansion is especially relevant given the ageing population and increasing prevalence of frailty. It also contributes to the education of junior surgeons, shaping future practices. NELA’s proactive approach underscores its commitment to adapting to evolving healthcare needs and improving patient outcomes.