685 Consent for Emergency Laparotomy - Factors Affecting Discussion of Risk of Mortality With Patients and Their Families, and Use of NELA Preoperative Risk Scores as a Tool for Enabling Informed Consent
G Geary, J Waterman, P Shah- Surgery
Abstract
Introduction
Emergency Laparotomy (EL) carries a high risk of morbidity and mortality. Preoperative predictive tools can be a useful means of calculating and communicating this risk. Patients and their families should understand the risk of mortality during the consent process for an EL; clinicians are legally and ethically obliged to provide them with such information. Our aim was to assess whether discussions with patients and their family’s surrounding mortality are adequately documented as part of providing informed consent, and factors affecting this.
Method
A retrospective cohort study was performed in a single district general hospital between July 2020 and December 2021. All adult patients undergoing EL of any indication were included. The NELA mortality risk tool was used to estimate the risk of postoperative mortality. Binary logistic regression analysis was performed to investigate the predictors of documented discussion regarding the risk of mortality with patients and their families. All statistical tests were two-tailed and statistical significance was assumed at P < 0.05.
Results
There were a total of 111 patients. Documented discussion regarding NELA risk score with patients and their families were seen in 42% and 32% of cases, respectively. NELA mortality risk score was an independent predictor of documented discussion regarding the risk of mortality with patients (OR: 1.04, 95% CI 1.00, 1.09, P = 0.039) and their families (OR: 1.05, 95% CI 1.01, 1.09, P = 0.014).
Conclusions
There is a need to improve discussions regarding the risk of mortality during the consent process in patients undergoing EL whether such risk is high or low.