WHEN RISK BECOMES REALITY: UNDERSTANDING MORTALITY AFTER EMERGENCY LAPAROTOMY balaji.jay73@gmail.com

 

WHEN RISK BECOMES REALITY: UNDERSTANDING MORTALITY AFTER EMERGENCY LAPAROTOMY

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United Kingdom

Oral or Poster

The National Emergency Laparotomy Audit (NELA) provides a validated risk prediction tool for 30-day mortality in emergency laparotomy. While overall mortality is tracked, there remains a question of whether high-risk cases could have been better managed with alternative strategies, including non-operative management or enhanced geriatric input.

A retrospective review was conducted of all emergency laparotomies performed at a UK district general hospital between December 2021 and March 2023. Data were collected on demographics, frailty, NELA score, preoperative imaging, and outcomes. Mortality cases were examined in detail to identify potentially avoidable factors.

A total of 190 laparotomies were performed, with 21 mortalities (11%): 20 emergency and 1 elective. Of the 21, 20 had preoperative CT scans, with an average reporting time of 3 hours. Sixteen patients (76%) had reports within 2 hours, and 12 (57%) within 1 hour, indicating efficient imaging pathways. The majority of mortalities occurred in patients over 80 years or in those over 65 years with significant frailty (frailty score >5). Discussion points included whether surgery was appropriate in these groups, and whether earlier involvement of geriatricians or stratified risk cut-offs (e.g., <5%, 5–30%, >30%) could aid shared decision-making.

While imaging turnaround was efficient, mortality remained concentrated among elderly and frail patients. Incorporating frailty scoring, refining NELA stratification, and routine geriatric input may strengthen prognostication and help identify patients for whom non-operative or palliative management may be more appropriate.