Year 10 Report Launch
The tenth annual patient report of the National Emergency Laparotomy Audit was released on 9th October 2025.
The report found that emergency bowel surgery mortality rates are at their lowest in a decade and the lowest since auditing began in 2013 at 8.1% 30 day mortality.
The length of stay has also reduced with the median length of stay down to 10 from 11 days in the year 9 report, which could represent savings to the NHS of more than £10 million annually.
Between April 2023 and April 2024, NELA analysed the care of 23,560 NHS patients admitted for emergency laparotomy across 176 hospitals in England and Wales. The audit is led by the Royal College of Anaesthetists in partnership with the Royal College of Surgeons of England and commissioned by the Healthcare Quality Improvement Partnership.
A positive impact
Mortality rates and postoperative length of hospital stay are key markers of care. The improvements reported demonstrate the positive impact of NELA over the last decade in helping clinicians to improve patient outcomes.
Challenges remain
Despite these advances, the audit highlights areas that still need urgent improvement, particularly around the timeliness of infection management and of access to surgery.
Timeliness of infection management
Only 15.4% of patients with suspected sepsis and 36.8% of patients with suspected infection received antibiotics within the national guidelines of one or three hours, respectively.
In both groups, around 25% of patients waited more than 5.8 hours until they first received any antibiotics.
Timeliness of arriving in theatre
Only 8.4% of patients with the most time-critical pathologies were admitted to theatre within the six-hour target after arriving in hospital and 75% waited more than 10 hours.
On average, female patients of all ages experience longer delays until arriving in theatre, although the reasons for this remain unclear. NELA intends to publish further subgroup analysis in coming months.
Direct communication about CT scanning
Urgent CT scans with findings critical to surgical decisions should be followed up with direct communication between the requesting clinician and the reporting radiologist. However, this only happened in 24.7% of cases.
Critical care bed capacity
Most high-risk patients (77.6%) were admitted to critical care following surgery, in line with national guidance. But 16.5% of high-risk patients received standard ward level care.
Specialist care for older patients and those living with frailty
Just 35.5% of patients over 80 or over 65 and living with frailty received specialist postoperative input into their care, despite it being associated with both reduced mortality and a shorter length of hospital stay.
Demand for this specialist care in many hospitals exceeds capacity.