Retrospective Identification of NoLap Cases in the Grange University Hospital (GUH)

Introduction

The NoLap arm was introduced in year 11 (Y11) of the National Emergency Laparotomy Audit (NELA) to obtain structured data on decision-making and outcomes in patients presenting with inclusion diagnoses who did not proceed to surgery. However, identification of patients presenting with the inclusion criteria for NoLap has been poor and was hypothesized to have resulted in inadequate data collection for Y11. This analysis aims to retrospectively identify patients who fit criteria for NoLap audit inclusion in Grange University Hospital (GUH) in Y11 of NELA.

Method

All adult patients admitted to GUH between 01/04/2024 and 31/03/2025 were included. Case identification was completed using NoLap audit inclusion diagnostic codes. Cases were excluded if a matching NELA entry was identified or if the patient underwent a non-NELA surgical procedure. Remaining records were assessed manually to confirm diagnosis meeting inclusion criteria and to seek if a definite ‘not for laparotomy’ decision had been made.

Results

202 individuals were identified by clinical codes, 59 were excluded as having had a surgical procedure on that admission. 19 patients were identified as having met NoLap criteria, compared to one patient record that was submitted to Y11 audit. 10 had bowel perforation, 9 had ischaemic bowel.

Conclusion

To fulfil the aim of the NoLap audit of collecting data on NoLap patients, accurate patient numbers and identification are prerequisite. This study has shown that in Y11, prospective data collection significantly underreported NoLap numbers in GUH. Our work suggests that the expected number should be approximately 1 NoLap for every 10 laparotomies performed on this site. Further work is required to ensure robust prospective data collection to accurately identify patients to be included in the NoLap audit and to establish whether this ratio is maintained nationally.