WE5.10 Death in the early post-operative period: recognising the concept of non-beneficiality in emergency laparotomy and modelling its predictors

Abstract

Background The publication of data from the National Emergency Laparotomy Audit (NELA) has resulted in overall improvement in post-operative mortality rates. However, little is known about the characteristics of patients that die in the immediate post-operative period. These patients may represent a missed opportunity for the consideration of palliation. We describe this specific group of patients where death occurred within three days of emergency laparotomy, and investigate predictors of early mortality. Methods All patients enrolled in the NELA database from December 2013–2020 were included. Early post-operative death was defined as all-cause mortality within three days of emergency laparotomy. Multi-level logistic regression was carried out with potentially clinically important predictors defined a priori. Frailty was modelled separately due to missing data. Results Four per cent of patients (7,442/180,987) died in the early post-operative period and 85% were admitted to critical care post-operatively. Median NELA risk score was 32.4% compared to 3.8% in the rest of the cohort (p<0.001). One in four patients were commenced on an end-of-life pathway following laparotomy. Significant predictors on multivariate analysis included female sex, increasing age, higher ASA, surgery for intestinal ischaemia or perforation, hypotension, reduced GCS, urgency of surgery, cardiac and respiratory signs (n=178,442). The addition of frailty (n=52,766) was also predictive (OR 1.37; 95% CI 1.22–1.55) when added to the model. Conclusion Early post-operative mortality is associated with quantifiable predictable factors in addition to the NELA risk score. This finding has significant implications for the multi-disciplinary team having shared decision-making discussions with extremely high-risk patients.