{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:25:31Z","timestamp":1777379131984,"version":"3.51.4"},"reference-count":24,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Anaesth Intensive Care"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>\n                    The preoperative risk score and key recommendations designed by the National Emergency Laparotomy Audit (NELA) have resulted in improved outcomes for patients undergoing emergency laparotomy. However, the recommended routine intensive care\/high dependency unit (ICU) admission for high-risk patients is not always logistically possible and predictive models are needed to identify patients who will benefit. We conducted a study of patients undergoing emergency laparotomy at our tertiary hospital in Western Australia between 2018 and 2023 to identify factors that were associated with the need for ICU admission after emergency laparotomy, as defined by the requirement for a vasopressor infusion, continuous renal replacement therapy or ventilation. Of 1100 patients identified, 875 were included in the primary analysis. In multivariate analysis, the only independent predictive factors of the need for ICU therapies were the American Society of Anesthesiologists grade (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    =0.017) and peak intraoperative serum lactate concentration &gt;2 mmol\/L (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    =0.038). An increased NELA score was associated with mortality; however, it was not associated with the requirement for any ICU therapy (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    =0.993). Although only 35.8% of high-risk patients were admitted to ICU, there was no apparent increase in adverse outcomes including mortality or unexpected ICU admission, and 27.4% of patients that were admitted to ICU received no specific therapies. This study provides a basis for the development of new predictive models for ICU admission post emergency laparotomy, and suggests the possibility that routine elective admission might not necessarily add value beyond that achieved by other NELA standards.\n                  <\/jats:p>","DOI":"10.1177\/0310057x251377313","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T11:59:42Z","timestamp":1761134382000},"page":"140-147","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Utility of the NELA score and other variables in predicting the need for ICU admission post emergency laparotomy"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8320-7140","authenticated-orcid":false,"given":"Ashleigh J","family":"Punch","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7240-9679","authenticated-orcid":false,"given":"Bradley A","family":"Wibrow","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, Australia"},{"name":"School of Medicine, University of Western Australia, Crawley, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0461-681X","authenticated-orcid":false,"given":"Angela","family":"Jacques","sequence":"additional","affiliation":[{"name":"Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia"},{"name":"Department of Research, Sir Charles Gairdner Hospital, Perth, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amyleigh","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siobhan N","family":"Delaney","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7927-524X","authenticated-orcid":false,"given":"Matthew H","family":"Anstey","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, Australia"},{"name":"School of Medicine, University of Western Australia, Crawley, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.09.024"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2016.0248"},{"key":"e_1_3_4_4_2","author":"The ANZELA-QI Working Party","year":"2022","unstructured":"The ANZELA-QI Working Party. Australia and New Zealand Emergency Laparotomy Audit \u2013 Quality Improvement (ANZELA-QI): Second ANZELA-QI program summary report 1 January 2020\u201331 December 2021. 2022.","journal-title":"Australia and New Zealand Emergency Laparotomy Audit \u2013 Quality Improvement (ANZELA-QI): Second ANZELA-QI program summary report 1 January 2020\u201331 December 2021"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14793"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31829ce8fd"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-022-06723-6"},{"key":"e_1_3_4_8_2","unstructured":"ANZICS Centre for Outcome Resource Evaluation 2023 Report Melbourne Australia https:\/\/www.anzics.org\/annual-reports\/ (accessed 9 March 2025)."},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X221105291"},{"key":"e_1_3_4_10_2","unstructured":"Royal Australasian College of Surgeons. ANZ Emergency Laparotomy Audit \u2013 Quality Improvement Project https:\/\/www.surgeons.org\/en\/research-audit\/morbidity-audits\/morbidity-audits-managed-by-racs\/anz-emergency-laparotomy-audit-quality-improvement (accessed 4 April 2023)."},{"key":"e_1_3_4_11_2","unstructured":"NELA. Parsimonious NELA risk calculator https:\/\/data.nela.org.uk\/riskcalculator\/ (accessed 16 February 2025)."},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-025-02105-4"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2013.02.048"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-019-0418-9"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-023-02075-7"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001024"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.12069"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znac246"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccrj.2023.10.010"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/ans.19260"},{"key":"e_1_3_4_21_2","volume-title":"Eighth patient report of the National Emergency Laparotomy Audit","author":"NELA Project Team","year":"2023","unstructured":"NELA Project Team. Eighth patient report of the National Emergency Laparotomy Audit. London: Royal College of Anaesthetists, 2023."},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znab134.390"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.50718"},{"key":"e_1_3_4_24_2","volume-title":"Mortality prediction for emergency laparotomy in Australia","author":"Kefalianos J.","year":"2023","unstructured":"Kefalianos J. Mortality prediction for emergency laparotomy in Australia. Deakin University, 2023."},{"key":"e_1_3_4_25_2","unstructured":"Geriatric Medicine Research. 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