SP9.11 - Characteristics and predictive factors associated with on table mortality in emergency laparotomy: insights from the National Emergency Laparotomy Audit

Abstract Aims Mortality during emergency laparotomy is a rare but significant event that can have a profound impact on patient’s families and the healthcare team. The aims of this study were to define the frequency of this occurrence within the National Emergency Laparotomy Audit (NELA) database and to investigate predictive factors. Methods All patients entered into the database between 2013-2020 were included. Multilevel logistic regression was used, with clinically important factors identified a a priori, to identify variables associated with intra-operative mortality. Results The overall incidence of intra-operative mortality was 1 in 400 cases (450/180,985). There was no difference in mortality rate between day-time and night-time operations. These patients presented critically unwell with signs of shock (50%, 225/450) and an ASA grade of ≥4 (76%, 343/450). Their baseline function status was good with a high proportion residing in their own home (97%, 437/450) and minimal signs of frailty. Acute mesenteric ischaemia was the indication for laparotomy for 46% of patients (207/450) and was associated with a threefold increase in the risk of intra-operative death (OR 2.97 (95% CI 2.35-3.75)). Other important predictive factors were hypotension at presentation (OR 1.56 (95% CI 1.22-1.99)) and a blood lactate of 4-6 (OR 3.89 (95% CI 2.62-5.76)). Conclusions Intra-operative mortality during emergency laparotomy is rare but remains a significantly higher occurrence than in other emergency surgical specialities. The strong association with acute mesenteric ischaemia necessitates optimisation of UK emergency department assessment pathways and more nuanced discussions about the risks of surgery in such high-risk patients.