WP5.13 - National Emergency Laparotomy (NELA) critical care admissions: A cohort study

Abstract Aims NELA is committed to enhancing quality of peri-operative care of patients undergoing emergency laparotomy. NELA emphasizes importance of identifying high risk patients, who are associated with significant morbidity & mortality. Critical care allows close monitoring, organ (basic/advanced) support. Aim of study is to review the NELA critical care patients. Methods Cohort study of NELA patients that received post-operative ITU care (direct/indirect admission) at single centre. Descriptive demography, and outcomes were evaluated. NELA parsimonious risk & CCMDS ITU scores used. NELA patient that did not require ITU care were controls. Results NELA critical care (n = 400) NELA non critical care (n = 466) Mann Whitney U (p value) Deaths (n) - (n) Age(yrs) 71.8 64.0 < 0.0001 Sex(M:F) 173 : 227 220 : 246 NS ASA 3 2 < 0.0001 BMI(kg/m2) 26.3 25.0 NS Lap(n) 67 168 Open(n) 333 293 Op time(mins) 131.0 109.4 < 0.0001 LOS(days) 18 9.5 < 0.0001 Deaths 30 day 50 25 60 day 66 37 90 day 73 40 Lactate(mmol/L) 2.4 1.8 <0.01 WCC(x109/L) 13.0 11.8 <0.05 CRP(mg/L) 90.1 56.6 <0.0001 Physiological-score 25.6 19.8 <0.0001 Operative-severity-score 17.9 15.9 <0.0001 Prepossum-score 21.6 7.5 <0.0001 PPmortality-score 11.9 4.9 <0.0001 PPmorbidity-score 77.3 55.7 <0.0001 Survival Rate (%) 1styear 75.4 86.2 5thyear 53.8 70.8 Logrank 10thyear 41.1 58.7 p<0.0001 Conclusion NELA critical care patients had poorer survival rates in our study. Theatre return or indirect critical care transfers can adversely affect survival. These patients were older, frail, multiple co-morbid status. NELA parsimonious mortality risk score >5% should encourage consultant level supervision, mortality risk score >10% should encourage direct critical care involvement.