Purpose: Emergency laparotomy (EL) is a high-risk procedure, particularly in elderly patients. [1] This study aims to assess postoperative outcomes in patients aged 65 years and older who underwent EL. Methodology: A retrospective audit was conducted on patients aged 65 years and older who underwent EL at Rockhampton Hospital, Queensland, Australia, between January 2021 and June 2023. A total of 87 patients were included. Data collected included demographic details, American Society of Anesthesiologists (ASA) scores, operative duration, length of hospital stay (LOS), postoperative complications, ICU admissions, discharge disposition, 30-day mortality, and 30-day readmission rates. Statistical analysis was performed to assess variable associations. Results: The mean age was 76.8 ± 8.3 years, with an equal distribution of males and females (44/87). The mean operative duration was 111.1 ± 82.3 minutes, and the mean LOS was 17.4 ± 26 days. The 30-day mortality rate was 13% (11/87), with no significant differences observed in age, ASA scores, sex, comorbidities, LOS or surgical duration. ICU admission was required in 55% (48/87), and 16% (14/87) required rehabilitation, with 5 patients needing nursing home placement. Additionally, 30% (26/87) of patients were readmitted within 30 days. Conclusion: EL in elderly patients is associated with high morbidity and prolonged hospitalization. Many patients required ICU admission and rehabilitation, with a significant number experiencing loss of independence. References: 1.Cheng DT, Miyata N, Asomah F. An 8-year retrospective review of emergency laparotomy outcomes in a Queensland rural hospital. Aust J Rural Health. 2023 Aug 27. doi:10.1111/ajr.13034.