Purpose of Study To investigate risk prediction tools for emergency laparotomy (EL) in older adults ≥65-years-old in a tertiary Acute Surgical Unit. Methods Patients who underwent EL between April 2021 and April 2022 had baseline characteristics and Clinical Frailty Scale (CFS) prospectively collected; Charlson’s Comorbidity Index (CCI), National Exploratory Laparotomy Audit (NELA), Physiological and Operative Severity (P-Possum), National Surgical Quality Improvement Program (NSQIP) scores, and clinical outcomes retrospectively collected. Binary logistics regression was adjusted for age, CFS and CCI. Results Of 114 patients undergoing EL, average age 76.7±7.6 years old, 46.5% (n=53) were not frail (CFS 1-3), 41.2% (n=47) mildly frail (CFS 4-5), 12.3% (n=14) severely frail (CFS ≥5); 4.4% (n=5) mildly, 34.2% (n=39) moderately, 61.4% (n=70) severely comorbid. 30-day and 1-year mortality were 10.5% (n=12) and 16.7% (n=19) respectively. Before adjustment, NELA was associated with 1.05 (95% CI, 1.02-1.10, p=0.007) and 1.08 (95% CI, 1.04-1.12, p<0.001), P-Possum 1.02 (95% CI, 1.00-1.05, p=0.061) and 1.04 (95% CI, 1.02-1.07, p=0.001), NSQIP-mortality 1.06 (95% CI, 1.02-1.10, p=0.007) and 1.06 (95% CI, 1.02-1.10, p=0.006) times 30-day and 1-year mortality respectively. After multivariable adjustment, NELA and P-Possum were not associated with 30-day mortality. Increments in NSQIP-mortality was associated with 1.05 times 30-day mortality (95% CI, 1.01-1.10, p=0.029). Increments in NELA was associated with 1.06 (95% CI, 1.02-1.11, p=0.005), P-Possum 1.03 (95% CI, 1.01-1.07, p=0.021) and NSQIP-mortality 1.05 (95% CI, 1.01-1.10, p=0.030) 1-year mortality respectively. Conclusion For EL in older adults with frailty and comorbidity, NSQIP provides complementary prediction for short-term mortality. NELA, P-Possum and NSQIP provide risk-prediction for mid-term mortality.