Emergency laparotomy (opening of the abdomen, known as ELAP) is performed on over 30,000 patients a year in the UK – mostly for bowel conditions.

The National Emergency Laparotomy Audit (NELA) has assessed this cohort of patients, identifying areas of need and improving patient outcomes. The original Emergency Laparotomy and Frailty Study (ELF), funded by Bowel Research UK, examined data on older people undergoing ELAP and recommended frailty scoring as standard.

Sadly, many older patients who are sick enough to be deemed as needing emergency laparotomy do not undergo it due to frailty or other vulnerabilities (NoLAP). While our understanding of ELAP patients has massively increased thanks to research, little is known about this group – how many patients end up in this category? What are their characteristics? What are the reasons for not undergoing surgery? what are their short-term outcomes? We urgently need to understand these things to improve care for this highly vulnerable group, in the same way as NELA has done for those who do have the surgery. This will be the focus of the second Emergency Laparotomy and Frailty Study – ELF 2.

Only two small published works have reported on NoLAP with one group finding NoLAPs accounted for 6% of all patients being considered for ELAP, contrasting with a Scottish study that reported 32%. Furthermore, despite the majority of NoLAP decisions being a result of ‘poor patient fitness’, a third of patients are alive 30 days later. There is an urgent clinical need to characterise this NoLAP population to improve care and quality of life for older emergency surgical patients.

This prospective multi-centred UK cohort study aims to identify a consecutive series of older adults presenting with acute abdominal pathology (overwhelmingly due to bowel disease) potentially treatable by ELAP where the decision is made not to undergo surgery.

Armed with better data and evidence, we will be able to improve decision making and outcomes for a group of patients who urgently need our help.