Despite national improvement initiatives, such as the National Emergency Laparotomy Audit (NELA), clinical outcomes for older people have remained significantly worse than for their younger counterparts. Frailty confers additional complexity, with risk of mortality and morbidity persisting up to 12 months following surgery, and one-third of this group requiring new or additional social-care support following surgery.¹

Shared decision-making around emergency laparotomy is challenging for both patients and clinicians. When reflecting on decision-making, older patients have indicated that potential long-term quality of life implications, including loss of independence, are more of a priority than numerical mortality-risk assessment tools.² Yet, patient-reported measures are not routinely collected within NELA, nor reflected widely in research studies. ‘Perioperative care of older people living with frailty’, published by the Centre for Perioperative Care and British Geriatrics Society, highlights research into patient experience as a key recommendation.³