Related Experiment Video
Updated: Jan 4, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
The need for Paediatric Emergency Laparotomy Audit (PELA) in the UK
C K Sinha1, E Rye1, R Sunderland1
1St George's University Hospitals NHS Foundation Trust, UK.
Insights
This study highlights the need for a pediatric emergency laparotomy audit, revealing baseline data on care standards and outcomes in children. Findings suggest a mortality rate of 4.3%, emphasizing the importance of further multi-center research.
Area of Science:
- Pediatric surgery
- Surgical outcomes
- Healthcare audits
Background:
- The National Emergency Laparotomy Audit (NELA) identified critical issues in adult emergency laparotomies.
- No comparable data exists for pediatric emergency laparotomies.
- This study addresses the need for a pediatric-specific audit.
Purpose of the Study:
- To investigate the necessity of a pediatric emergency laparotomy audit.
- To establish baseline data on care processes and outcomes for pediatric emergency laparotomies.
Main Methods:
- Retrospective data collection following NELA guidelines.
- Analysis of 161 pediatric patients over 7.5 years.
- Utilized QuickCalcs for statistical analysis.
Main Results:
- Median age of patients was 2.8 years; 49% were American Society of Anesthesiologists (ASA) grade ≥2.
- Common indications included adhesive bowel obstruction (37%) and intussusception (27%).
- 30-day mortality was 3.1%, overall mortality 4.3%; 51% required intensive care.
Conclusions:
- This single-center study provides initial data on pediatric emergency laparotomy care and outcomes.
- Results indicate a need for a larger, multi-center study to validate findings.
- Highlights potential areas for quality improvement in pediatric surgical care.
Introduction:
The National Emergency Laparotomy Audit (NELA) has raised serious concerns about the processes of care and outcomes in adult emergency laparotomies in the UK. To date, no comparable data have been published for children. The aim of this study was to investigate the need for a similar audit in children.
Methods:
Data were collected retrospectively following NELA guidelines. Results were analysed using QuickCalcs (GraphPad Software, La Jolla, CA, US).
Results:
The study period spanned 7.5 years. A total of 161 patients were identified for inclusion in the audit. The median patient age was 2.8 years. Half (49%) of the cohort were deemed ASA (American Society of Anesthesiologists) grade ≥2. A history of previous abdominal surgery was noted in 37% of the patients. The median time from admission to operation was 15 hours. Over a third (39%) of the operations were performed out of hours. The most common indications for surgery comprised adhesive bowel obstruction (37%), intussusception (27%) and volvulus (9%).The median length of hospital stay was 8 days with the median postoperative stay being 6 days (NELA data 10.6 days). Half (51%) of the cases required intensive care following surgery. The 30-day mortality rate was 3.1%. The overall mortality rate was 4.3% (NELA data 16%). Patient care was led by a consultant surgeon in 100% of cases (NELA data 89%).
Conclusions:
This is the first study in children that provides baseline data about the standards of care and outcomes from a single centre paediatric emergency laparotomy audit. A larger study using data from multiple centres would be of great benefit.
