292 Outcomes of NoLap Patients in the National Emergency Laparotomy Audit at a Single Tertiary Centre

Abstract Aim The NoLap category of the National Emergency Laparotomy Audit (NELA), introduced in April 2024, captures outcomes for patients presenting with acute bowel ischaemia or perforation in whom emergency surgery was indicated but not performed - either due to the patient’s frailty and high surgical risk or by patient choice. This study aimed to evaluate outcomes in this cohort and identify opportunities to improve palliative and end-of-life care. Method We conducted a prospective, single-centre study between February 2024 and February 2025. Adults (≥18years) with radiological evidence of bowel perforation or ischaemia, for whom surgery was indicated but not undertaken due to significant comorbidities or patient preference, were included. Patients who underwent radiological or endoscopic therapeutic interventions were excluded. The primary outcome was overall survival. Secondary outcomes included multidisciplinary involvement and advance care planning. Results Seventeen patients met inclusion criteria. The cohort was predominantly female (94.1%) with a median age of 87 years. The overall mortality rate was 64.7%. The median Clinical Frailty Score was 8, and the mean NELA-predicted mortality was 51.8%. All patients had CT-confirmed diagnoses. On admission, only 41.1% had an advance care plan or DNACPR in place. Following the decision for conservative management, 88.2% received formal input from palliative care or geriatric medicine. Conclusions This early experience highlights a frail and high-risk patient group often underrepresented in audit and quality improvement initiatives. Despite high predicted mortality, proactive end-of-life care planning was often lacking. Early palliative services involvement and structured advance planning are essential to support patient-centred care.