Beyond high‐risk: analysis of the outcomes of extreme‐risk patients in the National Emergency Laparotomy Audit

• Published in: Anaesthesia 2023-11, Vol.78 (11), p.1376-1385
• Main Authors: Javanmard‐Emamghissi, H., Doleman, B., Lund, J. N., Lockwood, S., Hare, S., Pearce, L., Moug, S., Tierney, G. M.
• Format: Article
• Language: English
• Subjects: Clinical decision making; Informed consent; Laparotomy; Mortality; Mortality risk; Patients; Quality of life; Risk analysis; Risk groups; Survival
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.16130

Patients who require emergency laparotomy are defined as high risk if their 30‐day predicted risk of mortality is ≥ 5%. Despite a large difference in the characteristics of patients with a mortality risk score of between 5% and 50%, these outcomes are aggregated by the National Emergency Laparotomy Audit (NELA). Our aim was to describe the outcomes of the cohort of patients at extreme risk of death, which we defined as having a NELA‐predicted 30‐day mortality of ≥ 50%. All patients enrolled in the NELA database between December 2012 and 2020 were included. We compared patient characteristics; length of hospital stay; rates of unplanned return to the operating theatre; and 90‐day survival in extreme‐risk groups (predicted ≥ 50%) and high‐risk patients (predicted 5–49%). Of 161,337 patients, 5193 (3.2%) had a predicted mortality of ≥ 50%. When patients were further subdivided, 2437 (47%) had predicted mortality of 50–59% (group 50–59); 1484 (29%) predicted mortality of 60–69% (group 60–69); 840 (16%) predicted mortality of 70–79% (group 70–79); and 423 (8%) predicted mortality of ≥ 80% (group 80+). Extreme‐risk patients were significantly more likely to have been admitted electively than high‐risk patients (p