304 Impact of ICU Bed Availability on Admission of High-Risk Emergency Laparotomy Patients: An Audit of NELA and P-POSSUM Correlation

Abstract Aim To assess whether ICU admission following emergency laparotomy aligns with preoperative mortality risk scores (NELA or P-POSSUM) Method A retrospective audit was conducted on emergency laparotomy cases performed between January 2019 and November 2024 at Huddersfield Royal Infirmary. Cases were identified using the hospital’s theatre electronic record system (Bluespier) by two independent reviewers. Electronic patient records were reviewed to obtain NELA or P-POSSUM scores. ICU bed data was recorded daily and obtained from ICU staff. Patients were stratified by risk category (low, medium, high) based on their predicted 30-day mortality, and analysed against ICU admission status. Statistical analysis included chi-square tests. Results Of 620 laparotomies, 241 had NELA scores and 86 had P-POSSUM scores documented. Upper GI laparotomies made up 4% of the total number of laparotomies. The mean NELA and P-POSSUM scores were 9.74% and 14.19% respectively. Among high-risk patients (NELA or P-POSSUM >10%), 31.94% and 28.12% respectively were not admitted to ICU despite the availability of ICU beds on most days. Chi-square analysis showed a significant association between risk category and ICU admission (p < 0.00001). Conclusions ICU admissions generally aligned with higher risk scores, particularly NELA. However, a notable proportion of high-risk patients were not admitted despite available beds, suggesting the need for improved documentation, risk-based triage, and escalation protocols to ensure equitable critical care access.