NOT ALL HIGH-RISK IS EQUAL: OUTCOMES BY NELA SCORE IN EMERGENCY LAPAROTOMY balaji.jay73@gmail.com

 

NOT ALL HIGH-RISK IS EQUAL: OUTCOMES BY NELA SCORE IN EMERGENCY LAPAROTOMY

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United Kingdom

Oral or Poster

The National Emergency Laparotomy Audit (NELA) in the UK defines high-risk laparotomy as a predicted 30-day mortality ≥5%. However, this broad threshold encompasses patients with widely differing prognoses, from modest to extreme risk. This study aimed to evaluate outcomes using a more refined stratification: low (<5%), high (5–50%), and extreme (>50%) risk.

A retrospective analysis was conducted on 55 consecutive patients undergoing emergency laparotomy between July–December 2023 at a single UK district hospital. Patients were stratified by NELA score into three categories. Baseline variables (age, ASA grade, NELA score) and outcomes (30-day and 90-day mortality, reoperation, and critical care requirement) were compared.

Of the 55 patients, 22 (40%) were low risk, 25 (45%) high risk, and 8 (15%) extreme risk. Mortality was 0% in the low-risk group. Among high-risk patients, 1 (4%) died within 30 days and 1 (4%) within 90 days. In the extreme group, 2 (25%) died within 30 days and 1 (12.5%) by 90 days. Reoperation occurred in none of the low-risk, 1 (4%) of the high-risk, and 1 (12.5%) of the extreme-risk patients.

Stratifying NELA scores reveals clinically meaningful gradients in outcomes, challenging the current ≥5% “high-risk” definition. Differentiating between high and extreme risk enhances prognostication, strengthens shared decision-making, and may improve perioperative planning.