Compliance with NELA and BGS-CPOC Standards in Older Patients Undergoing Emergency Laparotomy: A Single-Centre Audit

Compliance with NELA and BGS-CPOC Standards in Older Patients Undergoing Emergency Laparotomy: A Single-Centre Audit

Introduction 

Frailty is associated with increased postoperative complications, prolonged hospital stay and higher mortality following emergency laparotomy. The British Geriatrics Society–Centre for Perioperative Care (BGS–CPOC) and the National Emergency Laparotomy Audit (NELA) recommend: frailty assessment within four hours of admission in all patients aged ≥65 years;  comprehensive geriatric assessment (CGA) for patients with frailty and all patients aged ≥80 years; and documented mortality risk assessment. This audit evaluated local compliance with these standards in older adults undergoing emergency laparotomy.

Methods

We undertook a retrospective single-centre audit of all patients aged ≥65 years who underwent emergency laparotomy between 31 March 2025 and 1 April 2026. Data were extracted from electronic patient records and NELA database. Primary outcomes were documentation of the Clinical Frailty Score (CFS; frailty defined as CFS ≥5), mortality risk documentation, and postoperative geriatric review. Secondary outcomes included critical care admission, length of stay and mortality.

Results 

Seventy-four patients were included; 58.1% were female and 47.3% were aged ≥80 years. Frailty was recorded in 47/74 (63.5%) patients, but no CFS score was documented on admission. Mortality risk assessment was documented in 10/74 (13.5%) patients. Among those aged ≥80 years, 20/35 (57.1%) received postoperative geriatric review. Four patients aged 65–79 years were documented as frail; two of these received geriatric input, suggesting frailty was under-recognised in this age group. Eleven patients (14.9%) died; only one had postoperative geriatric review. Postoperative critical care admission for high-risk patients was 84.8%, indicating good adherence to the national standard. Mean length of stay was 15.5 days, near the 15‑day benchmark.

Conclusion 

Overall, compliance with BGS–CPOC and NELA standards was poor, particularly regarding timely frailty assessment and mortality risk documentation. In response, we have implemented targeted quality-improvement measures including staff education, reminder posters in the Surgical Assessment Unit and an emergency laparotomy checklist, with re-audit planned to assess their impact.