WP4.8 - Separating the sheep from the goat - Outcomes Based on Low, High and Extreme Risk NELA scoring

Abstract Background According to the UK National Emergency Laparotomy Audit (NELA), high-risk emergency laparotomy is defined as any patient with a NELA risk score of ≥ 5%, indicating a predicted mortality rate of 5% or higher within 30 days after the procedure. However, scores ranging between 5%-100% fall within the similar ambit of requiring intensive care support. There is a lack of distinction among the patients in the high-risk group with measurable outcomes. Given the broad margin, we stratified NELA mortality into low risk (<5%), high risk (5-50%) and extreme risk (>50%). The study was retrospective, involving 150 laparotomies, and looked at the outcome amongst various stratifications. Methods A retrospective analysis of 150 patients who underwent emergency laparotomy was evaluated against the documented NELA scoring and stratified into categories. Baseline characteristics, encompassing age, usual place of residence, ASA physical status, and NELA score, were analyzed to compare the three groups (low, high and extreme risk). The outcomes under consideration included 30- and 90-day mortality, hospital length of stay, re-operation rates and the length of stay in critical care. Results There existed clear outcomes with the 30-day mortality and re-operation rates between the three groups. Our study highlighted the gap that exists in the clinical prognosis and shared decision-making in patients with high (5-50%) and extreme risk (>50%) NELA scores. Further, we worked out a risk stratification model that could guide consenting these patients. Conclusions Outcomes based on NELA score stratification will only strengthen the shared decision-making process for a patient with an objective understanding of the risks involved.