FTP6.9 Death is not the worst that can happen: exploring extreme-risk in the National Emergency Laparotomy Audit
Hannah Javanmard-Emamghissi, Brett Doleman, Sarah Hare, Jon Lund, Susan Moug, Gillian Tierney- Surgery
Abstract
Background
A National Emergency Laparotomy Audit (NELA) mortality risk score of >5% is considered high-risk. A threshold for very high-risk or extreme-risk has not been defined, and the outcomes of these patients are unknown.
Method
All adult patients enrolled in the NELA database December 2012-2020 were included. Patients were categorised into groups based on predicted mortality score; 50-59% (Group A), 60-69% (Group B), 70-79% (Group C) and >80% (Group D). These groups were compared for demographics and outcomes such as length of hospital stay (LOS), rates of unplanned return to theatre and 90-day survival rates.
Results
Of 161,337 patients, 5196 had a predicted mortality of ≥50% (3.2%). Group A accounted for 2437 (47%) of patients, Group B 1484 (29%), Group C 843 (16%) and Group D 432 (8%). Patient age decreased with increasing predicted mortality, with a median age of 77 in Group A and 75 in Group D (p<0.05). LOS increased from 26 [16-44] days in Group A to 35 [20-54] days in Group D, compared to the NELA median of 15 days. Rates of unplanned return to theatre were double in all extreme-risk groups when compared to the NELA average (11.3% vs 4.8%). The ninety-day survival was 43% in Group A, 34% in Group B, 27% in Group C and 17% in Group D.
Conclusion
The NELA score accurately predicted mortality in the extreme-risk group. In addition, for those that survive, they experience double the rate of unplanned theatre returns and double the LOS than the average NELA patient.