Emergency Laparotomy Patients Research Articles

Intra-abdominal Pressure Measurement as a Predictor of Postoperative Wound Complications in Patients Undergoing Emergency Laparotomy: A Prospective Observational Study.

Introduction Elevated intra-abdominal pressure (IAP) hampers the effective functioning of intra- and extra-abdominal organs. Despite the abundance of knowledge, routine measurement of IAP still needs to be widely incorporated in managing at-risk patients. The present study intends to assess the need for IAP measurement on abdominal wound healing in emergency laparotomy patients. Methods This prospective study was carried out over 24 months in patients undergoing emergency laparotomy. The IAP was measured at admission, immediately after surgery, and during the early postoperative period at 6, 12, 24, 48, and 72 hours. The patients were evaluated for the development of wound-related complications over a follow-up period of three months post-operatively. Results Seventy-two patients were enrolled. At admission, 54 (75%) patients had intra-abdominal hypertension (IAH), of which three patients had evidence of abdominal compartment syndrome. Thirty-one (43%) patients developed postoperative wound infections. The overall incidence of wound infection was significantly higher in patients with IAH (54.3% vs. 24%, p-value = 0.04, Pearson's Chi-squared test). The frequency of wound dehiscence was greater (19.6 % vs. 4.3 %, p-value 0.14, Fischer's exact test) in patients with IAH. The median duration of hospital stay (13 vs. 8 days, p-value 0.02, Mann-Whitney U test) and healing time (30.5 vs. 18 days, p-value 0.02, Mann-Whitney U test) was significantly higher in patients with IAH. Conclusion Measurement of IAP is a relatively simple procedure that should be incorporated into the routine postoperative care of surgical patients. The presence of elevated IAP can identify the subset of patients at risk of increased postoperative wound complications.

The open abdomen in mesenteric ischemia: A tool for patients undergoing revascularization.

We examined outcomes in Acute Mesenteric Ischemia (AMI) with the hypothesis that Open Abdomen (OA) is associated with decreased mortality. We performed a cohort study reviewing NSQIP emergency laparotomy patients, 2016-2020, with a postoperative diagnosis of mesenteric ischemia. OA was defined using flags for patients without fascial closure. Logistic regression was used with outcomes of 30-day mortality and several secondary outcomes. Out of 5514 cases, 4624 (83.9%) underwent resection and 387 (7.0%) underwent revascularization. The OA rate was 32.6%. 10.8% of patients who were closed required reoperation. After adjustment for demographics, transfer status, comorbidities, preoperative variables including creatinine, white blood cell count, and anemia, as well as operative time, OA was associated with OR 1.58 for mortality (95% CI [1.38, 1.81], p<0.001). Among revascularizations, there was no such association (p=0.528). OA was associated with ventilator support >48h (OR 4.04, 95% CI [3.55, 4.62], and p<0.001). OA in AMI was associated with increased mortality and prolonged ventilation. This is not so in revascularization patients, and 1 in 10 patients who underwent primary closure required reoperation. OA should be considered in specific cases of AMI. Retrospective cohort, Level III.

Frailty in Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) Patients

Abstract Aims Early identification of frailty is essential in the older emergency surgical patient. The latest NELA report highlights the importance of care of the elderly reviews in reducing mortality in this patient population. In our organisation, the geriatrician led Surgical Acute Frailty Team (SAFT) reviews patients aged ≥ 65 years included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Our aim was to establish frailty identification in ELLSA patients and to review outcomes on discharge. Methods A subset of data collected as part of our organisation’s ELLSA was reviewed. Data included documentation of Clinical Frailty Scale Score (CFS), review pre-operatively and during admission by SAFT and discharge destinations. Results 146 patients aged ≥ 65 years underwent emergency surgery as defined by ELLSA criteria from July 2022 to August 2023. 98.6% of patients had a documented CFS score (mean 3.6). 87.7% of patients were reviewed by SAFT; 63.3% of patients had a pre-operative frailty review. 70% of patients were discharged home independently with 7% requiring a care package on discharge. Conclusions In our organisation, frailty assessment in emergency laparotomy patients is significantly above the 31.8% documented in the 8th NELA report. The majority of patients are discharged home without additional support. Shared decision making is vital in this patient cohort. We have established frailty screening on admission, introduced a weekly MDT for ELLSA patients and installed a designated ELLSA patient MDT board with the aim of ensuring 100% of ELLSA patients aged ≥ 65 years have a geriatrician review.

Assessment for the risk of malnutrition and nutritional support in older emergency laparotomy patients: a clinical audit

Abstract Aims Patients undergoing urgent abdominal surgery should undergo an assessment of the risk of malnutrition upon admission using the Malnutrition Universal Screening Tool (MUST). This assessment should trigger a response when patients are categorised as high-risk. This clinical audit aimed to determine whether older patients included in the National Emergency Laparotomy Audit (NELA) were identified as being at risk of malnutrition and whether they received appropriate nutritional support to address deficiencies if they were classed as high-risk as per the recommendations of the NICE (2017) guidelines. Methods Patients entered into the NELA database at a single NHS trust who were over 65 or older between January 1, 2021, and December 31, 2022, were included. The patient records were reviewed for the MUST score upon admission, and the presence of nutritional supplementation prescriptions, or dietetic referrals following the identification of a high-risk MUST score of 2 or above. Results Out of the 300 older NELA patients included in this clinical audit, 98% had a recorded MUST score. Between them, 114 patients had a high-risk MUST score, but 35% of these high-risk patients did not undergo a dietetic review. Additionally, 24% of high-risk patients received neither oral nor parenteral supplementation. Conclusions High-risk MUST scores in older NELA patients are readily available to surgical teams within the electronic patient record but do not consistently lead to interventions addressing nutritional deficiencies and nutritional screening is not currently included in NELA.

The effects of forced air warming system on the hemodynamic status, pain intensity, tremors, nausea and vomiting in candidates of emergency laparotomy patients: a double-blind randomized clinical trial

Objective: During emergency laparotomy surgeries, a wide incision is usually created in the abdomen causing the exposure of visceral organs to cold temperatures in the operation room. Other factors such as excessive stress, intra-operation blood transfusion, and prolonged anesthesia increase the risk of hypothermia in these patients. In this study, we studied the effects of forced air warming systems on the hemodynamic status, pain intensity, tremors, nausea and vomiting in emergency laparotomy patients.&#x0D; Methods: In the present double-blinded clinical trial, 80 candidates for emergency laparotomy were randomized into two groups: intervention (patients receiving forced air warming during anesthesia) and control (patients without an active warming system). Patients’ hemodynamic status (during anesthesia and at post anesthesia care unit (PACU), pain intensity, opioids received, tremors, nausea, vomiting, and antiemetics administration were compared between the two groups.&#x0D; Results: The amounts of opioids (P=0.041) and relaxants (P=0.039) received by the patients were significantly lower in the intervention group than in the control group. The hemodynamic status was more stable in the patients of the intervention group than those in the control group at all times measured. Pain intensity (per minute) at the PACU was significantly higher in the control group than in the intervention group (P=0.041). Among the patients admitted to the PACU, participants with no tremors (P=0.005) or nausea (P=0.005) were significantly higher in the intervention group than in the control group. Also, in the recovery unit, patients in the intervention group received significantly lower amounts of opioids (i.e., mg of pethidine, P=0.036) and antiemetics (P=0.011) compared to the control group.&#x0D; Conclusion: The use of a forced air warming system in the operation room stabilizes the hemodynamic status and reduces the pain intensity, tremors, nausea and vomiting in emergency laparotomy patients. As a non-pharmacological strategy, this method was observed to have satisfactory safety.

Prospective study of management in surgical emergency laparotomy patients in Alexandria Main University Hospital

Background Emergency laparotomies form a broad group of time-sensitive surgeries done on variable patient population. Purpose The purpose of this study was to evaluate the incidence and details of emergency laparotomy, its complications, and mortality rates. Patients and methods This prospective study was held in Alexandria University Hospitals in the duration between April 2022 and September 2022 and included all patients were subjected to emergency laparotomies (481 patients). Preoperative, operative, and postoperative data were recorded. Results Out of 481 patients, 398 patients had nontraumatic causes and 83 patients had traumatic cause. The commonest nontraumatic cause was appendicitis, and the commonest traumatic cause were stab and road traffic accident. Most of trauma patients were males and had younger age than nontrauma groups. Intraoperative complications were reported at comparable frequencies between both groups and the commonest complications were atrial fibrillation (AF) and failed extubation. Postoperative complications were higher among nontrauma group and septic shock was the main complication. Postoperative mortality was higher among nontrauma group. Conclusion Emergency laparotomies were indicated for nontraumatic causes at higher rate the traumatic cause with higher postoperative complications and mortality rates.

Ultrasonographic assessment of brachial artery reactivity as a predictor of adverse outcome in patients undergoing emergency laparotomy for perforated peritonitis - Prospective observational study.

This study aimed to assess if pre- and postoperative parameters of brachial artery reactivity (BAR), like flow-mediated dilation (FMD) and hyperaemic velocity (HV), could predict in-hospital mortality in perforation peritonitis patients undergoing emergency laparotomy. In this prospective observational study, adult patients with perforation peritonitis undergoing emergency laparotomy were recruited. FMD and HV were measured preoperatively, postoperatively and at 24 and 48 h post-surgery. Adult patients undergoing elective laparotomy served as the control group. The primary outcome was in-hospital mortality. Baseline and BAR parameters were compared between survivors and non-survivors. Risk factors for mortality were identified by univariate analysis. Prognostic performances of BAR parameters were assessed by different models using logistic regression. All statistical analyses were performed on STATA version 13 for Mac OS. Seventy-six emergency laparotomy patients were recruited, and 26 died during the hospital stay. FMD and HV were comparable at all time points between survivors and non-survivors, except that HV was higher in survivors at 48 h post-surgery (median [interquartile range] 1.28 [1.16-1.49] vs. 1.16 [0.86-1.35], P = 0.010]. HV at 48 h predicted mortality (adjusted odds ratio [OR] [95% confidence interval] 21.05 [1.04-422.43], P = 0.046), and a model consisting of age, Acute Physiology and Chronic Health Evaluation (APACHE) score and HV at 48 h was the best predictor of mortality (area under the receiver operating characteristic (AUROC) curve 0.82). HV, as measured by ultrasonography of the brachial artery at 48 h postoperatively, is a good predictor of mortality in patients undergoing emergency laparotomy for perforation peritonitis.

526 Combining Sarcopenia and ASA Status to Inform Emergency Laparotomy Outcomes: Could It Be That Simple?

Abstract Aim Emergency laparotomy mortality prediction tools are usually complex multipoint scoring systems. Our aim was to assess a 2 point system comprising radiological sarcopenia plus simplified ASA (PM;L3/sASA) as a potential predictor of 30-, 90- and 365- day mortality in Emergency Laparotomy patients, and compare this to current widely used tools such as NELA, P-Possum and ACS-NSQIP. Method A retrospective analysis was conducted across four hospitals, identifying 500 patients who underwent emergency laparotomies between 2016-2017 and had contemporaneous abdomino-pelvic CT scans. Radiological sarcopenia was measured using the PM:L3 ratio on a cross-sectional axial CT slice. PM:L3, NELA, ACS-NSQIP, and P-POSSUM, as well as simplified ASA (sASA) were retrospectively calculated and assessed as potential predictors of 30-, 90-, and 365-day mortality. Results ACS-NSQIP, NELA, P-POSSUM and PM:L3/sASA were each statistically significant predictors of 30-day, 90-day and 365-day mortality (p&amp;lt;0.001). Logistic regression models of 30-, 90- and 365-day mortality containing just the two predictors PM:L3 and simplified ASA exhibited AUCs of 0.838, 0.805 and 0.775 respectively, which are comparable with the best currently used predictors ACS-NSQIP and NELA. Conclusions Combining PM:L3 with ASA scores appears to be a significant predictor of 30-, 90-, and 365-day mortality in emergency laparotomy patients in Australia. The results are comparable with some of the best performing widely used risk assessment tools and provide a more time-efficient and accessible method of performing risk assessments in Emergency Laparotomy patients.

932 Provision of a 7 Day Radiology Service for Emergency Laparotomy Patients: Are We Compliant with Current Standards?

Abstract Introduction According to “NHS services, Seven Days a week Forum”, a radiological scan should be reported within 1 hour for “critical” requests and within 12 hours for “urgent “ones. Requests are considered critical when the test will alter patient’s management at the time; and urgent if the test will alter management but not necessarily that day. Aim The aim was to audit whether the above standards were met for urgent and critical requests for patients undergoing emergency laparotomy. Method A single centre retrospective audit of adults undergoing emergency laparotomy between 01/02/2014 to 30/12/2021 was performed. Data was collected from the National Emergency Laparotomy Audit database. A total of 1748 patient records were analysed out of which 1309 were included. Patients who underwent pre-operative CT scan in the same admission were included. Patients who had CT prior to admission for laparotomy and those who had more than one operative intervention were excluded. CT time was calculated as time taken from CT examination to reporting. Results Standards were met for 27.5% of all investigations ordered. 0.16% of Critical, and 53% of urgent scans were reported within required times. There was no difference in standards met between weekends and weekdays. Conclusions Limitations include the retrospective nature of data collection and amendment time being recorded instead of original reporting time for some scans. Recommendations include allowing time frames for standards and retaining interim report times.

SP1.1 Comparison of major abdominal emergency surgery outcomes across different organisational models of emergency surgical care: analysis of the UK NELA national database

Abstract Aims Emergency General Surgery (EGS) admissions are high risk and account for 14000 intensive care admissions costing over £88 million per year. This aim of this study is to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies. Methods Data was obtained from the NELA database. Patients were dichotomised into either EGS hospital or non - EGS Hospital. EGS hospital is defined as a hospital where &amp;gt;5 % of the in-hours emergency laparotomy operating is performed by an emergency general surgeon. The primary outcome was in – hospital mortality. Secondary outcomes were ITU length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias. Results 115,509 patients were included in the final analysis. Patient characteristics were similar between the 2 groups. Following propensity score weighting, mean SMD reduced from 0.034 to &amp;lt;0.001. In-hospital mortality was similar (10.8% vs 11.1%, p=0.094), with mean length of stay (16.7 vs 16.1 days, p&amp;lt;0.001) and ITU stay (2.8 vs 2.6 days, p&amp;lt;0.001) persistently longer in patients treated in EGS systems. Conclusions There is no significant association between the emergency surgery hospital model of care and in – hospital mortality in emergency laparotomy patients, suggesting the emergency surgery model of care can be utilised effectively without adversely affecting patient outcomes. There is, however, a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the UK.

ThTP5.2 Outcome of polypharmacy in frail patients post emergency laparotomy

Abstract Aims The causal effect relationship between frailty and polypharmacy is not clearly established. Medications are used to treat co- morbidities that cause frailty but the side effects of the drugs could also be the stressors leading to frailty. Moreover, high risk of mortality is associated with frail emergency laparotomy patients. We aim to explore the association between 30- day mortality and frailty with polypharmacy. Methods A prospective database of emergency laparotomy (EmLap) patients in a busy district hospital was analysed. Patients ≥40 years old who underwent EmLap as per NELA criteria were included. Frailty was assessed via Clinical Frailty Score with score ≥4 as frail. Polypharmacy was defined as ≥5 daily medications. Statistical analysis was performed using logistic regression and p value of &amp;lt;0.05 was considered significant. Results 100 patients were included with 41% male and median age of 66 years. The overall 30- day mortality rate was 9%. Frailty was present in 49% and mortality rate was 16.3% (OR 79.76, p= 0.0121). Polypharmacy was found in 36% and mortality rate was 16.7% (OR 4.07, p= 0.045). There was significant association between frailty and polypharmacy (p=0.012). When both frailty and polypharmacy were present (25%), the mortality rate was 20% (OR 5.55, p= 0.026). Conclusion Frailty increases risk of polypharmacy and polypharmacy poses risk of worsening frailty, Mortality rate post EmLap is higher when EmLap patients are both frail and have polypharmacy. It is important to rationalise and review patient’s drug therapy in the community as well as in hospital.

ThTP5.3 Outcome of weekend physiotherapy input post emergency laparotomy

Abstract Aims Early ambulatory has been shown to reduce risk of morbidity and length of stay. It is evident in elective laparotomy patients but there is limited data on emergency laparotomy patients. We aim to explore the outcome of morbidity and physiotherapy input over weekend. Methods Patients ≥18 years old underwent emergency laparotomy (EmLap) as per NELA criteria from July 2021 to Dec 2021 in a busy district hospital were reviewed. Data on demographics, physiotherapy input and morbidity (post-operative ileus and pneumonia) were analysed. P-value of &amp;lt;0.05 was considered significant. Results A total of 81 patients were included with 56% female and median age 69 years. Ratio of smoker: Non-smoker: Ex-smoker was 1:4:1. 74% were seen by physiotherapist over the weekend (POW) and 48% had chest physiotherapy post-operative day 1. The overall rate of post-operative ileus was 18.5% (19% no-POW vs 18.3% POW; p= 0.942) while the rate of post-operative pneumonia was 11.1% with 2/3 non-smoker (9.5% non-POW vs 11.7% POW; p= 0.855). Median post-operative length of stay was 10 days (8 days No-POW vs 11 days POW). Conclusion Physiotherapy input post EmLap over the weekend did not significantly improve morbidity. Weekend input is provided by the oncall physiotherapist and the requirement of the service could reflect the high risk status of patients. Besides physiotherapists, ward nurses play an important role in continuous encouragement of mobilisation post-operative to reduce morbidity rate.

MOY 1 Variation in decision making around high-risk emergency laparotomy over time

Abstract Background There have been huge improvements in the ten years of the National Emergency Laparotomy Audit (NELA), notably in the assessment and recognition of high-risk emergency laparotomy patients, with associated improvements in outcomes. However, guidance around emergency laparotomy multi-disciplinary decision making remains sparse. The aim of this work was to examine the NELA database for variation in emergency laparotomy patient demographics over time. Method All patients enrolled in the NELA database December 2012-2020 were included. Patients were grouped according to their year of entry into the database (Years 1-7) and were assessed for NELA score, futile surgery (death in &amp;lt;72 hours of emergency laparotomy), and their admitting hospital. Results A total of 161,337 patient enrolled in the database had a documented NELA risk score. The mean NELA score decreased over time: 11.6% in Year 1 compared to 8.9% in Year 7. The number of extreme-risk patients decreased accordingly; overall 3.2% (n=5196) had a 30-day mortality risk of ≥50%, accounting for 4.3% of surgeries in Year 1, and only 2.2% in Year 7 (p&amp;lt;0.001). Although extreme-risk laparotomies were carried out in 183 hospitals, 1 in 5 were carried out in just 16 participating hospitals. The number of futile surgeries also decreased over time from 5% (n=1034) in Year 1 to 3.2% (n=705) in Year 7 (p&amp;lt;0.001). Conclusion High-risk, extreme risk and futile surgeries have decreased significantly annually since NELA began auditing surgical outcomes, however the missing puzzle piece remains patients that do not have emergency laparotomy.

ThTP5.10 A clinical audit of assessment of the risk of malnutrition and the subsequent nutritional support prescribed for older emergency laparotomy patients

Abstract Aims Patients should have assessment of the risk for malnutrition on admission using a Malnutrition Universal Screening Tool (MUST) and this should trigger a response if patients are categorised as high risk (National Institute for Health Care and Excellence, 2017). This clinical audit sought to identify if older patients undergoing emergency laparotomy were identified as at risk of malnutrition with subsequent interventions to address protein and energy deficiencies. Methods Patients entered onto the National Emergency Laparotomy Audit (NELA) database who were over 65 years of age during 1/1/21 to 31/12/22 were included. The patient records were screened for the MUST score on admission and whether nutritional supplementation was prescribed, or dietetic referral made, following the recording of a high-risk MUST score. Results Three hundred patients were included in the audit with 99.3% of the patients having a MUST score recorded on admission. One hundred and fourteen patients recorded a high MUST score, with 35% of the high MUST patients not receiving a dietetic review and 24% receiving neither oral nor parenteral supplementation. Mortality at 30 days was 13.9%. The wide variety of supplementation prescribed was changed to a protein and energy-based supplement upon dietetic review. Conclusions MUST scores are available to surgical teams, but high-risk scores do not always trigger an intervention to address deficiencies in older NELA patients. A protocol to ensure consistent approaches to supplementation before dietetic review would reduce variation and education of prescribers is needed to address the importance of prescribing protein-based supplements is needed.

Comparison of major abdominal emergency surgery outcomes across organizational models of emergency surgical care: Analysis of the UK NELA national database.

Emergency general surgery (EGS) admissions account for a large proportion of surgical care and represent the majority of surgical patients who suffer in-hospital mortality. Health care systems continue to experience growing demand for emergency services: one way in which this is being increasingly addressed is dedicated subspecialty teams for emergency surgical admissions, most commonly termed "emergency general surgery" in the United Kingdom. This study aims to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies. Data was obtained from the National Emergency Laparotomy Audit database. Patients were dichotomized into EGS hospital or non-EGS hospital. Emergency general surgery hospital is defined as a hospital where >50% of in-hours emergency laparotomy operating is performed by an emergency general surgeon. The primary outcome was in-hospital mortality. Secondary outcomes were intensive therapy unit (ITU) length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias. There were 115,509 patients from 175 hospitals included in the final analysis. The EGS hospital care group included 5,789 patients versus 109,720 patients in the non-EGS group. Following propensity score weighting, mean standardized mean difference reduced from 0.055 to <0.001. In-hospital mortality was similar (10.8% vs. 11.1%, p = 0.094), with mean length of stay (16.7 days vs. 16.1 days, p < 0.001) and ITU stay (2.8 days vs. 2.6 days, p < 0.001) persistently longer in patients treated in EGS systems. No significant association between the emergency surgery hospital model of care and in-hospital mortality in emergency laparotomy patients was seen. There is a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the United Kingdom. Prognostic and Epidemiological; Level III.

Validation of the NELA risk prediction model in emergency abdominal surgery.

Risk prediction models are frequently used to identify high-risk patients undergoing emergency laparotomy. The National Emergency Laparotomy Audit (NELA) developed a risk prediction model specifically for emergency laparotomy patients, which was recently updated. In this study, we validated the updated NELA model in an external population. Furthermore, we compared it with three other risk prediction models: the original NELA model, the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) model, and the American Society of Anesthesiologists Physical Status (ASA-PS). We included adult patients undergoing emergency laparotomy at Zealand University Hospital, from March 2017 to January 2019, and Herlev Hospital, from November 2017 to January 2020. Variables included in the risk prediction models were collected retrospectively from the electronic patient records. Discrimination of the risk prediction models was evaluated with area under the curve (AUC) statistics, and calibration was assessed with Cox calibration regression. The primary outcome was 30-day mortality. Out of 1226 included patients, 146 patients (11.9%) died within 30 days. AUC (95% confidence interval) for 30-day mortality was 0.85 (0.82-0.88) for the updated NELA model, 0.84 (0.81-0.87) for the original NELA model, 0.81 (0.77-0.84) for the P-POSSUM model, and 0.76 (0.72-0.79) for the ASA-PS model. Calibration showed underestimation of mortality risk for both the updated NELA, original NELA and P-POSSUM models. The updated NELA risk prediction model performs well in this external validation study and may be used in similar settings. However, the model should only be used to discriminate between low- and high-risk patients, and not for prediction of individual risk due to underestimation of mortality.

O051 Combining sarcopenia and asa status to inform emergency laparotomy outcomes: could it be that simple?

Abstract Introduction Emergency laparotomy mortality prediction tools are usually multipoint scoring systems such as NELA, ACS-NSQIP, and P-POSSUM. However, these tools are time consuming and complex to use. Sarcopenia on CT scans is correlated with mortality in emergency laparotomy patients and we explored the combination of this (as measured by PM:L3) with ASA as a simple and efficient tool to predict the outcome of Emergency Laparotomies. Methods A retrospective analysis was conducted across four hospitals, identifying 500 patients who underwent emergency laparotomies between 2016-2017 and had contemporaneous abdomino-pelvic CT scans. Radiological sarcopenia was measured using the PM:L3 ratio on a cross-sectional axial CT slice. PM:L3, NELA, ACS-NSQIP, and P-POSSUM, as well as simplified ASA (sASA) were retrospectively calculated and assessed as potential predictors of 30-, 90-, and 365-day mortality. Results ACS-NSQIP, NELA, P-POSSUM and PM:L3/sASA were each statistically significant predictors of 30-day, 90-day and 365-day mortality (p&amp;lt;0.001). Logistic regression models of 30-, 90- and 365-day mortality containing just the two predictors PM:L3 and simplified ASA exhibited AUCs of 0.838, 0.805 and 0.775 respectively, which are comparable with the best currently used predictors ACS-NSQIP and NELA. Conclusion Combining PM:L3 with ASA scores appears to be a significant predictor of 30-, 90-, and 365-day mortality in emergency laparotomy patients in Australia. The results are comparable with some of the best performing widely used risk assessment tools and provide a more time-efficient and accessible method of performing risk assessments in Emergency Laparotomy patients.

Screening for malnutrition in emergency laparotomy patients: a comparison of three tools.

Malnourished patients undergoing emergency laparotomy are at risk of significant morbidity. The optimum screening tool to identify such patients in practice and research is yet to be determined. This study aims to compare the performance of three nutrition risk tools in predicting time without enteral nutrition in this population. A prospective cohort study (NCT04696367) was conducted across two sites, recruiting patients undergoing National Emergency Laparotomy Audit eligible procedures. Data collected included demographics, diagnosis, procedure and outcomes. Nutrition risk was assessed using three tools: Malnutrition Universal Screening Tool (MUST) score, Nutritional Risk Index (NRI) and Nutritional Risk Score 2002 (NRS-2002). Complications were assessed with the Comprehensive Complication Index. Quality of life was measured at baseline and 5 days postsurgery using EQ-5D-5L. A total of 59 patients were recruited. Median age was 69 years. Of the 59 participants, 23 were judged high risk using MUST score, 13 using NRS and 8 using NRI. Median time to restart enteral intake was 7 days (interquartile range 7-14). Time without intake was correlated with increasing score using MUST (r=0.463, p<0.001) and NRS-2002 (r=0.296, p=0.03) but not NRI (r=-0.121, p=0.38). High-risk nutritional groups also had increased length of hospital stay, but not complication scores. Patients undergoing emergency laparotomy spend a prolonged time without enteral nutrition. Although all nutritional tools demonstrated some propensity to identify patients at higher risk of needing nutritional support, their performance was variable. Nevertheless, some may be useful in future clinical studies.

Effectiveness of Face mask only oxygenation and apnoeic oxygenation in addition to face mask in sustaining PaO2 during rapid sequence induction - A randomized control trial.

Apnoeic oxygenation, although useful during elective intubations, has not shown consistent beneficial results during emergency intubations in critically ill patients. We aimed to study the effectiveness of adding apnoeic oxygenation to our routine practice of using facemask alone, in emergency laparotomy patients needing rapid sequence induction (RSI), for sustaining partial pressure of oxygen (PaO2). Seventy-two patients undergoing RSI for emergency laparotomy were randomly allocated to either receive pre-oxygenation with 5 L/min of oxygen (O2) with a facemask (Group-FM) or apnoeic oxygenation with 10 L/min of O2 through a nasal catheter in addition to pre-oxygenation (Group-NC). Apnoea (90 s) was allowed from the removal of the facemask before the resumption of ventilation. Arterial blood gas analysis was done at the baseline, following pre-oxygenation and after 90 s of apnoea to study the PaO2 and partial pressure of carbon dioxide (PaCO2). The circuit O2 concentrations (fraction of inspired [FiO2] and end-tidal [EtO2]) were also noted to ensure a steady state of O2 uptake was reached. The circuit O2 concentrations were 90 ± 4% in group FM and 93 ± 5% in Group-NC. The FiO2-EtO2 difference was 4% in both groups. During the 90 s apnoea following pre-oxygenation, there was a fall in the PaO2 by 38% in Group-FM and 12% in Group-NC (P = 0.000). Increase in PaCO2 was similar in both groups (Group-FM: 44 [range: 32-55] mmHg; Group-NC: 42 [range: 33-54] mmHg, P = 0.809). Apnoeic insufflation of O2 using a nasopharyngeal catheter along with facemask oxygenation is more effective in sustaining PaO2 for 90 s during RSI than facemask-only oxygenation in patients undergoing emergency laparotomy.

EGS P24 Extended Thromboprophylaxis in the Prevention of Postoperative Venous Thromboembolism after Emergency Surgery

Abstract Background Venous thromboembolism (VTE) after emergency laparotomy is a significant cause of morbidity and mortality. Where extended thromboprophylaxis is used in the post-operative care of patients with colorectal malignancy or pelvic surgery, no such guideline exists for the patient undergoing emergency laparotomy. Arguably emergency laparotomy has one of the highest associated death rates of all types of surgery, greater than that of major elective GI surgery and involves high risk patients. The objective of this study is to ascertain the incidence of symptomatic VTE after emergency laparotomy within current thromboprophylaxis regimens at a district general hospital and consider the benefits of extended regimes in this patient cohort. Methods A database of all patients who underwent emergency laparotomy over a 12 month period from January 2019 to December 2019 was retrospectively analysed. The primary outcome was the incidence of symptomatic VTE within 90 days of emergency laparotomy. This was cross-referenced to known patient risk factors for thromboembolism. Results A total of 113 patients underwent emergency laparotomy during this period. Those who had multiple laparotomies and were duplicated or who died were excluded, leaving a total of 94 patients, 55 female and 39 male. 80 patients underwent a VTE prophylaxis regimen using perioperative and postoperative low-molecular-weight heparin (LMWH) based on their weight. The average length of stay was 18 days. 20 patients had an inpatient stay greater than 28 days and, therefore, received extended prophylaxis during their admission. 21 patients were given prolonged anticoagulation on discharge to complete a total of 28 days, 14 of these had suspected cancer intraoperatively, 6 were previously already anticoagulated. The postoperative VTE incidence was 6, 4 were diagnosed during admission and so received prolonged anticoagulation on discharge. 2 patients were not given prolonged VTE prophylaxis on discharge. Conclusions An extended VTE prophylaxis regimen using low-molecular-weight heparin is simple and effective and an accepted practice in the management of post operative colorectal cancer patients. A randomised control trial is likely needed to further explore the use of extended low molecular weight heparin in the postoperative care of emergency laparotomy patients.