Eighth patient report—emergency laparotomy (NELA, 9 February 2023)

Summary

Based on data from 22,132 patients who had emergency bowel surgery in England and Wales between December 2020 and November 2021, this report from the National Emergency Laparotomy Audit (NELA) found that improvements in in-hospital mortality have levelled off. As such, it calls for hospitals to continue to engage with NELA data collection and, in particular, to make use of real-time data and resources available to drive clinical and service quality improvement.

Content

Key findings

• Patients experienced long delays from time of arrival at hospital to time of surgery, including those with sepsis suspected at arrival in hospital (median 15.6 hours to theatre)
• Many patients (77.7%) with suspected sepsis on arrival did not receive antibiotics within an hour of arrival in hospital
• One in five high-risk patients did not receive postoperative care in a critical care unit.
• Frailty doubled the risk of mortality of patients aged 65 and over (13.0% vs 5.9%), but review by a member of the elderly care team was associated with a significant reduction in mortality (5.9% vs 9.5% amongst non-frail patients, and 13.0% vs 22.3% amongst frail patients). However, this is not routine practice in many hospitals.