Emergency Laparotomy and Frailty: A national multicentre study of older surgical patients undergoing emergency laparotomy (ELF)

A National Observational Cohort Study led by the North West Research Collaborative

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For any queries please contact the ELF Study Teams by Email at:

1) The ELF Study: ELFcommittee@hotmail.com

2) The ELF2 Study – Defining the Denominator: ELF2Study@gmail.com

ELF Study Updates

The ELF Study is now complete and the outputs are listed below.

The ELF2 Study will be running in 2020 and aims to assess frailty in older general surgical surgical patients where the decision is made not to perform an emergency laparotomy. For any sites interested in participating in ‘ELF2 – defining the denominator,’ please contact the ELF2 study team at: ELF2Study@gmail.com

The ELF Study – Summary

Objective: The ELF study aimed to document the prevalence of frailty in older adults undergoing emergency laparotomy and to explore relationships between frailty and postoperative morbidity and mortality.

Methods: An observational multicentre study was led by the North West Research Collaborative and supported by the Older Persons Surgical Outcomes Collaboration, the North West Surgical Trials Centre, and the Bowel Disease Research Foundation. 49 particpating sites contributed data from England, Scotland and Wales. All older adults undergoing emergency laparotomy were included. Preoperative frailty score was calculated using the Clinical Frailty Score: 1 (very fit) to 7 (severely frail). Primary outcome measures were the prevalence of frailty (CFS 5-7) and its association to mortality at 90 days. Secondary outcomes included 30-day mortality and morbidity, length of critical care stay and overall hospital stay.

Results: 937 adults underwent emergency laparotomy: frailty was present in 20%. 90-day mortality was 19.5%. After age and sex adjustment, the risk of 90-day mortality and 30 day mortality were directly associated with frailty. Increasing frailty was also associated with increased risk of complications, length of ICU stay and overall hospital stay.

Conclusions: A fifth of older adults undergoing emergency laparotomy are frail. The presence of frailty is associated with greater risks of postoperative mortality and morbidity and is independent of age. Frailty scoring should be integrated into acute surgical assessment practice to aid decision-making and development of novel postoperative strategies.


Chief Investigator: S Moug

Steering Committee: K Parmar, J Boyle, P Casey, I Farrell, J Law, I Maitra

Other Contributors: L Pearce, J Hewitt, B Carter, OPSOC (Older Persons Surgical Outcomes Collaboration)


Association of Coloproctology of Great Britain and Ireland British Journal of Surgery Best Paper Prize at the Annual ACPGBI meeting, Dublin, July 2019


Bowel Disease Research Foundation Observational Research Grant, 2018


· Parmar KL, Pearce L, Farrell I, Hewitt J, Moug S. Influence of frailty in older patients undergoing emergency laparotomy: a UK-based observational study. BMJ Open 2017;7(10):e017928. Published 2017 Oct 6. doi:10.1136/bmjopen- 2017-017928

· Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P, Maitra I, Farrell IS, Pearce L, Moug SJ and the ELF Study Group. Frailty in Older Patients Undergoing Emergency Laparotomy: Results From the UK Observational Emergency Laparotomy and Frailty (ELF) Study. Annals of Surgery 2019 Jun 7. doi: 10.1097/SLA.0000000000003402 [Epub ahead of print]


2018 (May): Association of Surgeons of Great Britain International Surgical Congress Liverpool, England

2018 (July): Association of Coloproctology of Great Britain and Ireland Annual Meeting Birmingham, England

2018 (Nov): Scottish Society Anaesthetists/ Royal College Anaesthetists Joint Meeting Dundee, Scotland

2018 (Nov): Association of Surgeons of Great Britain Emergency Laparotomy Meeting Birmingham, England

2019 (April): British Geriatric Society Spring Meeting Cardiff, Wales

2019 (July): Association of Coloproctology of Great Britain and Ireland Annual Meeting Dublin, Ireland (Winner of ACPGBI British Journal of Surgery Prize for Best Paper)


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