Based on patients admitted to hospitals in England, Wales and Northern Ireland between 24 April 2024 and 31 March 2025, this report is an audit of the standards of care for patients who do not undergo an emergency laparotomy (‘NoLap’ cohort).
The inclusion of NoLap patients enables valuable insights into variations in clinical care and outcomes for high-risk patients managed without surgery
This report is focussed 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. It found that there was no formal assessment of risk documented in 27.7% of cases, and so contains a recommendation to support improvement in address risk assessment.
Other key messages relate to frailty assessment, advance care planning, and end-of-life care. It also recommends that consideration be given to system level initiatives aimed at increasing the uptake and quality of end-of-life care training, including but not limited to, recognition of dying and the use of individualised end-of-life care plans and advance care planning.
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