Purpose Older patients undergoing emergency laparotomy are overrepresented and are at risk of poor post-operative outcomes that may not align with their goals. Goals of care (GOC) documentation remains low in older emergency laparotomy patients.1 Methods We conducted a prospective cohort study of emergency laparotomy patients aged ≥70 years between February 2024 and April 2025. Participants received phone follow-up 30 days after index surgery, assessing GOC recall, post-operative outcomes, EQ-5D-5L quality of life and decision satisfaction. If patients lacked capacity, next of kin were consented. Our primary aim was to assess recall of a preoperative GOC discussion. Our secondary aims were to correlate GOC recall with post-operative quality of life and decision satisfaction, and to determine rates of documented GOC conversations and GOC form completion. Results We recruited 80 participants and followed up 75. Twenty-nine (39%) participants recalled discussing GOC pre-operatively. Next of kin had higher recall than patients (n=13, 59% and n=16, 30% respectively). GOC recall was not associated with quality of life or decision satisfaction scores. Most patients (n=31, 89%) that recalled GOC reported that the GOC discussion was worthwhile. Although 89% (n=71) of participants had a completed GOC form pre-operatively, only 49% (n=39) had a documented GOC discussion. Older, more comorbid participants with higher degrees of frailty were more likely to have documented GOC discussions. Conclusions Although GOC recall by older patients and their next of kin was low following emergency abdominal surgery, these discussions were considered worthwhile. Clinical implications include careful documentation of values-based GOC discussions for older patients, consistent with upcoming Australian Commission on Safety and Quality in Health Care emergency laparotomy clinical care standards. 1.Pule LM et al. Br J Surg. 2023; 110(10):1367-73.