First National NoLap Report launched today

We are pleased to announce the first annual NoLap report from the National Emergency Laparotomy Audit (NELA). The report and its findings were publicly launched today at Anaesthesia 2026 by Dr Ee-Neng Loh, a NELA Fellow.  

The NELA team were commissioned by the Healthcare Quality Improvement Partnership (HQIP) to expand the scope of the NELA to include patients who meet the criteria for an emergency laparotomy, but who do not undergo surgery and who represent a clinically complex and high-risk population.

Data collected from 943 patients across 91 hospitals highlights the complexity of decision-making for patients who do not undergo emergency laparotomy.

The aim of the audit is to examine the standards of care delivered and outcomes for NoLap patients. This first patient report examines the care received by NoLap patients admitted to hospitals in England, Wales and Northern Ireland between 24 April 2024 and 31 March 2025.  

In its first year, the audit focused on patients presenting with radiological and/or clinical suspicion of bowel perforation or bowel ischaemia that would ordinarily warrant emergency surgical intervention, but for whom a decision was made not to proceed with surgery.

Key findings

• 88.8% were aged ≥65 years
• 80% were living with at least mild frailty
• 1 in 4 patients had no documented formal risk assessment
• Multispecialty decision-making occurred in only 50% of cases
• Patients or next-of-kin were not involved in 1 in 5 decisions
• 60% had no advance care plan prior to admission
• 1 in 4 were discharged without a DNACPR decision or advance care plan
• 30-day mortality was 80.2%
• 90-day mortality was 86.7%

With the first year of data now published, the team will work to define improvement goals and share additional improvement resources with local teams. As an ongoing national audit, data collection for this group of patients continues. We have just concluded our second year of data collection and will be reporting findings next year.  

Professor Iain Moppett, Chair of the Centre for Research and Improvement, commented:

"Sometimes surgery is not the best option or is not going to meet a patient's goals. This first report examining patients not having emergency abdominal surgery, shines a light on the importance of patient-centred decision making. Involving patients and their families in decisions and planning for what happens next will be a key area for improvement."