Emergency laparotomy is a commonly performed surgical procedure with a high mortality and morbidity. Several different operations can be classified as an emergency laparotomy and it is commonly performed on acutely unwell patients as a lifesaving procedure. Predicting outcomes preoperatively is paramount for patient information, planning of perioperative care and deciding on palliative therapies. This study aims to develop a reliable easy to use predictive score based on preoperative patient state. The score will be developed using a New Zealand wide multicentre prospective cohort. The risk assessment score will be introduced into a clinical pathway for emergency laparotomy patients. The clinical pathway will provide appropriate level care for high risk patients to reduce overall mortality and morbidity.