Peri-Operative Surgical Care Optimisation for Patients Requiring Emergency Surgery

Group 1 and 2: EmLap and NoLap patients (up to 30 participants) Patient inclusion/exclusion criteria should mirror NELA inclusion/exclusion criteria and NELA NoLap guidelines. NELA is the "National Emergency Laparotomy Audit" which recruits patients in Wales and England and there inclusion/exclusion criteria are widely accepted for use in Emergency General Surgery research. Inclusion criteria * Age \>65 years old * Able to communicate in English * Cognitively able to complete the survey/interviews * Able to provide informed, voluntary consent * First line treatment is expedited, urgent or emergency abdominal surgery on the gastrointestinal tract * Surgery can be laparoscopic or open approach Exclusion criteria * Age \<65 years old * NoLaps should be excluded if management involved interventional radiology or endoscopic procedures * Patients who are offered a period of conservative treatment are not automatically NoLap if surgery may ultimately be offered * Diagnosis of dementia or long-standing cognitive impairment * Elective laparotomy/laparoscopy * Diagnostic laparotomy/laparoscopy where no subsequent procedure is performed (however, if no procedure is performed because of inoperable pathology, then include) * All surgery involving the appendix or gallbladder, including any surgery relating to complications * Non-elective hernia repair without bowel resection or division of adhesions * Non-elective formation of colostomy or ileostomy * Trauma surgery (blunt or penetrating), vascular surgery, obstetric/gynaecological surgery or transplant surgery * Surgery for pathology of oesophagus, spleen, renal tract, kidneys, liver, gallbladder and biliary tree, pancreas or urinary tract Group 3: Families/Supporters (up to 30 participants) Inclusion criteria * Identified by the patient participant (only approached if nominated by patient) * Age \>18 years old * Able to communicate in English * Cognitively able to complete the survey/interviews * Able to provide informed, voluntary consent Exclusion criteria * Age\<18 years old * Lack of patient consent to family/supporter involvement Group 3: Consultants (interview:12-20 participants/survey: minimum 52 participants) Inclusion criteria * Key decision-makers will be identified in workstream 1 (likely: surgeons, intensivists and anaesthetists) * Post-CCT (Certificate of Completion of Training) * Participate in active on-call for EGS in a UK-based Hospital where they make decisions in EGS regularly Exclusion criteria • Consultants not done \>2 years of on-call