TU8.10 Should patients with a predicted NELA mortality of 5–10% be managed on ICU? An audit of the management of high-risk laparotomies as per NELA Guidelines

Abstract Aims The National Emergency Laparotomy Audit (NELA) has been pivotal in improving the care of patients undergoing emergency laparotomy. One key recommendation is ‘high-risk’ patients are managed on ICU post-operatively. We aimed to identify if there was a difference in outcomes between ‘high-risk patients’ (predicated NELA mortality >5%) managed on ICU or a surgical ward post-operatively. Methods We retrospectively analysed all patients registered to our hospitals NELA database from January 2019-September 2021, assessing if ‘high-risk’ patients were managed on ICU or general surgery wards post-operatively and the difference in outcomes between these two groups. Results 249 patients were included (138 Female). Over 80% of ‘high-risk’ patients were admitted to a ICU bed over the three-year period, as per NELA guidelines. 46 high-risk patients were managed on the ward post-operatively. Although there was no difference in age between the two groups, those admitted to ICU had a significantly higher predicated NELA mortality and higher mortality rate. Conclusions NELA predicted mortality helps to guide which patients may need a higher level of post-operative care. However, this study indicates that for some patients with a predicted mortality of 5–10%, ward-based care may be appropriate. In the context of increasingly stretched ICU resources, we believe further research is needed to identify whether some patients with a NELA mortality over 5% would be appropriate for ward management.