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​A new article has been published by the ELF group in the British Journal of Surgery, which looks at preadmission frailty for those undergoing emergency laparotomy and their post op care level at discharge. 

The link to the article is here.


A multicentre prospective cohort study that aims to:

  1. Identify a U.K. consecutive series of older adults presenting with acute abdominal pathology potentially treatable by emergency laparotomy where the decision is made not to undergo surgery (NoLAP) and their associated 90-day mortality.

  2. Collect, define and characterise the reasoning behind the NOLAP decision.

  3. Define potential prognostic markers for mortality that could aid decision-making in the future (including frailty, NELA score and sarcopenia).

  4. Compare aims 1 and 3 to those that underwent surgery (ELAP) during the same time frame as the NoLAP population.

The study is open to any hospital in the UK.


The protocol can be found here.


To get involved please contact us or fill in expression of interest (EOI) form here

The Results of the ELF study have been published in the Annals of Surgery, click here to read the abstract:

Please find attached a summary PDF presentation for use if you would like to present the study locally - This includes the study results and a list of oral presentations and publications to date.


We are thrilled to let you know that all your hard work has culminated in the ELF Study winning the ACPGBI BJS best paper prize, and in all 161 ELF collaborators being PubMed citable for our Annals of Surgery publication:

The Original Elf Study


Chief Investigator: Miss S Moug (Royal Alexandra Hospital NHS Trust)

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

Other Contributors:  L Pearce, J Hewitt, OPSOC (Older Persons Surical Outcomes Collaboration)



To evaluate whether the use of a recognised frailty score (Rock Wood 7 point scale) correlates with outcomes following emergency laparotomy in patients aged 65 and over.


The most recent NELA report (2016) has shown that over half of emergency general surgical patients are aged 65 and over and recommends that more be done to specifically target outcomes in this group of patients. Current risk prediction tools are mostly extrapolated from younger cohorts of patients and may be of less use in the older surgical population.

Frailty has been shown to be present in around 25% of older surgical patients with high pre-operative frailty scores being associated with increased post-operative complications, length of stay, 30 and 90 day mortality and likelihood of institutionalisation (Moug et al on behalf of OPSOC, Ann R Coll Surg Eng 2016; Hewitt et al, Am J Surg 2016; Farhat et al, J Trauma Acute Care Surg 2012). Most of these studies have been in elective rather than emergency surgery.

The use of a validated and easy to use frailty score may therefore permit the identification of at risk older emergency surgical patients and aid both decision making and the consent process.



This national observational study is being led by the North West Research Collaborative.  Data will be collected from fifty NHS hospitals across England, Scotland and Wales.  All patients aged 65 and over undergoing emergency laparotomy will be identified over an approximately three month period aiming for a sample size of 500 patients. Frailty scores will be assessed using the Rock Wood 7 point scale. The results database will be maintained using REDcap. Statistical support for data analysis is provided by OPSOC (Older Persons Surgical Outcomes Collaboraion).

Inclusion Criteria: Age 65+, Documented frailty score on admission, otherwise as per NELA


Exclusion Criteria: No documented frailty score, otherwise as per NELA

Outcome Measures: 90 day and 30 day mortality, Clavien Dindo post-operative complications, lowering of independence, length of stay, length of HDU/ICU stay, 30 day re-admission

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