524 Outcomes From Preoperative Risk Scoring for Emergency Laparotomy

Abstract

Abstract Aim Risk scoring systems can be used to predict outcome, facilitate perioperative decision making and guide management in emergency laparotomy (EL). This study aims to evaluate the differences in outcome between EL patients who were prospectively risk assessed and those who were not. Method A retrospective study was conducted on all 782 patients aged over 18 years who underwent EL at four Australian hospitals between 1 January 2018 and 31 December 2019. Data recorded included demographics, preoperative risk assessment, case urgency, involvement of anaesthetic and intensive care consultants, critical care bed requirement, mortality, and discharge destination. NELA scores were retrospectively calculated for all patients. Results 209 patients had been preoperatively risk assessed, with a mean NELA score of 16.45%, compared to 8.72% for those who were not preoperatively risk assessed. They tended towards a higher ASA score, were booked as a higher urgency operation, and were more likely to receive consultant led care by anaesthetics and intensivists. Postoperatively these patients had increased critical care bed utilisation, 30-day mortality was 14.4% compared to 5.8%, and by 365 days mortality rose to 24.9% compared to 13.8%. Conclusions Use of preoperative risk prediction scores does not in itself reduce risk of mortality. In a health system that does not mandate formal preoperative risk assessment, it appears that clinicians use preoperative risk assessment tools when they perceive risk to be higher, rather than as a routine part of emergency laparotomy care.