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TU8.10 Should patients with a predicted NELA mortality of 5–10% be managed on ICU? An audit of the management of high-risk laparotomies as per NELA Guidelines

Published Date: 09th August 2022

Publication Authors: Banks J, Macadam R

Aims
The National Emergency Laparotomy Audit (NELA) has been pivotal in improving the care of patients undergoing emergency laparotomy. One key recommendation is ‘high-risk’ patients are managed on ICU post-operatively. We aimed to identify if there was a difference in outcomes between ‘high-risk patients’ (predicated NELA mortality >5%) managed on ICU or a surgical ward post-operatively.

Methods
We retrospectively analysed all patients registered to our hospitals NELA database from January 2019-September 2021, assessing if ‘high-risk’ patients were managed on ICU or general surgery wards post-operatively and the difference in outcomes between these two groups.

Results
249 patients were included (138 Female). Over 80% of ‘high-risk’ patients were admitted to a ICU bed over the three-year period, as per NELA guidelines. 46 high-risk patients were managed on the ward post-operatively. Although there was no difference in age between the two groups, those admitted to ICU had a significantly higher predicated NELA mortality and higher mortality rate.

Conclusions
NELA predicted mortality helps to guide which patients may need a higher level of post-operative care. However, this study indicates that for some patients with a predicted mortality of 5–10%, ward-based care may be appropriate. In the context of increasingly stretched ICU resources, we believe further research is needed to identify whether some patients with a NELA mortality over 5% would be appropriate for ward management.

 

Banks, J; Macadam, R. (2022). TU8.10 Should patients with a predicted NELA mortality of 5–10% be managed on ICU? An audit of the management of high-risk laparotomies as per NELA Guidelines. British Journal of Surgery. 109(Suppl 5), pp.59-60. [Online]. Available at: https://doi.org/10.1093/bjs/znac248.083 [Accessed 20 February 2023]

 

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