"BENCHMARKING AND BRIDGING THE GAP: A PROSPECTIVE STUDY ON APPLYING NELA FRAMEWORK TO EMERGENCY LAPAROTOMY IN AN INDIAN TERTIARY CENTRE singhsaumya16@yahoo.com

 

"BENCHMARKING AND BRIDGING THE GAP: A PROSPECTIVE STUDY ON APPLYING NELA FRAMEWORK TO EMERGENCY LAPAROTOMY IN AN INDIAN TERTIARY CENTRE

4

India

Oral only

Emergency laparotomy (EL) is associated with high morbidity and mortality, particularly in low- and middle-income countries (LMICs), where standardized perioperative care pathways and national audit mechanisms are lacking. The National Emergency Laparotomy Audit (NELA) in the UK has demonstrated improved patient outcomes through structured perioperative assessment and decision-making. This study applies the NELA dataset to evaluate EL outcomes at a high-volume tertiary centre in North Indi

A prospective observational study was conducted at King George’s Medical University, Lucknow, over 18 months, enrolling 350 patients undergoing primary emergency laparotomy. Data were collected using the structured NELA dataset, including patient demographics, ASA physical status, Charlson Comorbidity Index (CCI), P-POSSUM scores, and intraoperative findings such as degree of peritoneal soiling. The primary outcomes measured were 30-day mortality and hospital length of stay (LOS). Statistical analysis was performed using SPSS version 25.

The 30-day mortality rate was 19.71%. ASA class III/IV (p = 0.012) and higher CCI scores (p < 0.001) were significantly associated with mortality. Peritoneal contamination, particularly fecal soiling, showed a near-significant association with increased mortality (p = 0.058). Age and gender were not statistically significant predictors. The mean LOS was 11.6 days. Compared to the NELA benchmark mortality of 9–10%, our outcomes were significantly worse.

Application of the NELA protocol in an Indian tertiary setting reveals elevated EL mortality, underscoring the urgent need for audit-based quality improvement, better ICU access, and standardized perioperative care pathways tailored to LMICs.