Tenth NELA report shows lowest mortality recorded for emergency bowel surgery

Emergency bowel surgery mortality rates are at their lowest in a decade, according to the latest data from the National Emergency Laparotomy Audit (NELA).

The tenth annual NELA report shows the lowest 30-day mortality rate since auditing began in 2013. Mortality has fallen from 11.7% to 8.1% - a drop of 3.6 percentage points, representing around 1,150 fewer patient deaths each year. 

Progress has also been made in reducing the length of hospital stays. The median length of stay has fallen to 10 days, down from 11 days the year before. This improvement could save the NHS more than £10 million annually.

Between April 2023 and April 2024, NELA analysed the care of 23,560 NHS patients admitted for emergency laparotomy across 176 hospitals in England and Wales. The audit is led by the Royal College of Anaesthetists in partnership with the Royal College of Surgeons of England and commissioned by the Healthcare Quality Improvement Partnership. 

A positive impact 

Mortality rates and postoperative length of hospital stay are key markers of care. The improvements reported demonstrate the positive impact of NELA over the last decade in helping clinicians to improve patient outcomes.  

Challenges remain

Despite these advances, the audit highlights areas that still need urgent improvement, particularly around the timeliness of infection management and  of access to surgery. 

Timeliness of infection management

• Only 15.4% of patients with suspected sepsis and 36.8% of patients with suspected infection received antibiotics within the national guidelines of one or three hours, respectively.
• In both groups, around 25% of patients waited more than 5.8 hours until they first received any antibiotics.

Timeliness of arriving in theatre 

• Only 8.4% of patients with the most time-critical pathologies were admitted to theatre within the six-hour target after arriving in hospital and 75% waited more than 10 hours. 

On average, female patients of all ages experience longer delays until arriving in theatre, although the reasons for this remain unclear. NELA intends to publish further subgroup analysis in coming months. 

Direct communication about CT scanning

• Urgent CT scans with findings critical to surgical decisions should be followed up with direct communication between the requesting clinician and the reporting radiologist. However, this only happened in 24.7% of cases.  

Critical care bed capacity

• Most high-risk patients (77.6%) were admitted to critical care following surgery, in line with national guidance. But 16.5% of high-risk patients received standard ward level care. 

Specialist care for older patients and those living with frailty

• Just 35.5% of patients over 80 or over 65 and living with frailty received specialist postoperative input into their care, despite it being associated with both reduced mortality and a shorter length of hospital stay.
• Demand for this specialist care in many hospitals exceeds capacity. 

Dr Claire Shannon, President of the Royal College of Anaesthetists, said:

“Emergency bowel surgery is high risk for patients and it’s encouraging to see a reduction in mortality and length of hospital stay. These improvements mean thousands of people have more time with their families. They also show the impact NELA has had over the last decade in improving outcomes for patients. 

“We now need to see improvements in other areas of care, such as managing infection and reducing delays in getting patients into theatre. The Royal College of Anaesthetists is committed to working with other Royal Colleges to implement the recommendations.”