Long-term accuracy of the National Emergency Laparotomy Audit risk score: Analysis of the impact of comorbidities on mortality 5 years after emergency laparotomy.

Abstract

The National Emergency Laparotomy Audit (NELA) risk prediction tool has demonstrated superiority in predicting 30-day mortality after emergency laparotomy (EL). The aim of our study was to evaluate the accuracy of NELA in calculating long-term (5 year) mortality and determine factors predicting long-term risk of death after EL. This retrospective cohort study included consecutive patients who underwent EL for any indication other than trauma between May 2012 and June 2017 at a large tertiary and academic teaching center. The primary outcome was all-cause postoperative mortality at 1 and 5 years. The c statistic (<1.0, excellent; <0.90, good; 0.80, fair; 0.70, poor) was used to assess accuracy of the NELA. Multivariable regression was used to identify independent risk factors for 5-year mortality after EL. From a total of 758 patients, observed mortality continued to increase from 15.4% at 1 year up to 31.4% at 5 years. The NELA risk score accurately classified deceased patients at both 1 year ( c = 0.82; 95% confidence interval [CI], 0.78-0.85) and 5 years ( c = 0.82, 0.79-0.85) after EL. History of ascites (adjusted odds ratio [aOR], 3.3; 1.0-11.3; p = 0.048), chronic obstructive pulmonary disease (aOR, 1.9; 1.1-3.4; p = 0.030), congestive heart failure (aOR, 3.6; 1.2-11.5; p = 0.025), myocardial infarction (aOR, 2.6; 1.5-4.6; p = 0.001), and a new cancer diagnosis (aOR, 2.8; 1.7-4.8; p < 0.0001) were independent prognostic factors for death 5 years after EL. Long-term prognosis after EL remains poor for at least 5 years postoperatively. The NELA score is accurately able to predict risk of death up to 5 years after EL. History of ascites, chronic obstructive pulmonary disease, congestive heart failure, myocardial infarction, and a new diagnosis of cancer were independent prognostic factors for long-term mortality after EL. Prognostic and Epidemiological; Level IV.