EGS P32 Audit for evaluation of using the National Emergency Laparotomy Audit (NELA) as risk assessment calculator for high-risk surgical patients undergoing emergency laparotomy

Abstract

Abstract Background A high-risk surgical operation called an emergency laparotomy has significant mortality and morbidity rate up to 10 times greater than the one performed electively. This entails a significant clinical and financial burden. The National Emergency Laparotomy Audit (NELA) was established in response to the aforementioned data in order to enhance the quality of care for patients having emergency laparotomies and to assist surgeons in reaching the best possible medical choices for their patients. The Emergency, Laparoscopic and Laparotomy Scottish Audit (ELLSA) is an equivalent system in Scotland. However, ELLSA is still not widely used as NELA. Methods This is a single-centre, retrospective audit to evaluate proper risk assessment and NELA registration for patients who had an emergency laparotomy in CEPOD between January 2022 and December 2022. The data was gathered from electronic clinical records via the hospital portal system. This analysis has included the following clinical data (Age, gender, indication of laparotomy, CEPOD form completion, NELA Score, hospital stay, and postoperative surgical outcome). The data was retrieved and analysed using a standard Excel data collection sheet. This audit aims to review and appraise our practise in relation to the NELA guidelines for risk assessment and emergency laparotomy. Results This analysis includes a total of 58 patients.35(60.3%) Males,23(39.7%) females. The included patients had an average age of 62. Almost 48% of these individuals had longer hospital stay more than 10 days. Approximately 21% of CEPOD booking forms had a recorded NELA score. A missing NELA registration form/risk assessment score was found in up to 97% of patient files and operation notes. A retrospective NELA assessment revealed a mortality rate of more than 20% for some included patients. The mortality rate was found to be high, at 21%, for NELA score of >20% mortality and >70% morbidity. Conclusions This Audit has shown that in order to completely comply with NELA guidelines, our practise must be significantly improved. We also need to give risk assessment documentation in patient records more consideration. The high death rate is attributed to patient and family requests for last-ditch surgical interventions, which can be difficult for surgeons to pull off.