NELA Prize The correlation between actual and predicted 30-day mortality for emergency laparotomies in adults, using National Emergency Laparotomy Audit (NELA) risk predicting tool – a multi-center, retrospective, observational, cohort study. (9th August 2022)

• Record Type: Journal Article
• Authors: Moscalu, Andrei; Saravanan, Balakrishnan; Kamal, Aryal; Sinclair, Martin
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 5
• Publication Date: 2022-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac246.012
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Emergency laparotomy (EL) is associated with a high 30-day-mortality (30-dm) risk. More than 22, 000 EL are performed annually in the UK, half of patients being ≥70 years. To improve patient outcomes, reliable preoperative risk assessment is of paramount importance. 30-dm can be assessed by a multitude of tools, including the National-Emergency-Laparotomy-Audit risk prediction tool (NELA-RPT). No one tool is perfect in preoperative risk prediction, with over or underprediction requiring special consideration. Methods: This is a multi-center, retrospective, observational, cohort study investigating the correlation between predicted 30-dm using NELA-RPT and actual 30-dm in patients aged ≥18, following EL, in two UK District General Hospitals, over a 2-year period. The correlation between actual 30-dm and the: day of the week the laparotomy took place, subspecialty of the main surgeon, grade of surgeon or primary-procedure performed were also analyzed. Sample size was calculated at 385. Statistical analysis was done using Stata Version 14.2. Results: 626 cases were analyzed. Male/female ratio was 1.17 and mean age 66.03. 50.65% cases were ≥70 years of age. Actual 30-dm for the entire cohort was 9.74% and 13.96% for the over 70's. Mean NELA-RPT 30-dm was 9.8% and 14.01% for over 70's. There was no statistically significant association between actual or NELA-RPT 30-dm and the day of the week the laparotomy took place, the subspecialty of the main operating surgeon, the grade of the main surgeon or the primary-procedure performed. Conclusion: NELA-RPT is a tool that can reliably estimate the 30-dm risk following EL.