We hope that this work will not simply add another metric to NELA reports, but will also provide useful information to clinicians, patients and organisations involved in the planning and delivery of emergency surgical care.

The NELA risk-prediction tool was designed to be used to adjust for differences in case mix between Centres but has additionally become an increasingly important tool to support shared decision-making. Population-level risk (as estimated by the NELA risk calculator) can provide a starting point for collaborative discussions, which combine data on risk with patient-specific clinical information and personal wishes.