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Mortality risk following colorectal surgery in elderly patients is high-especially following emergencyprocedures. This study aims to quantify the risks associated with emergency colorectal resection in older patients.A retrospective analysis was undertaken of the English Hospital Episode Statistics. Outcome markers included mortality and thepresence of medical complications occurring within 1 year of emergency colorectal resection.Between 2001 and 2007, 36 767 emergency colorectal operations were performed on patients aged > 69 years. Patients were classified into age-groups: I (70-75 years), II (76-80 years) and III (> 80 years). 1-year mortality was 34.7%, 41.6% and 51.2% for Groups I, II and III respectively (P < 0.001). Following case-mix adjustment advanced age was identified as an independentpredictor of death at 1-year post-surgery (OR: Group III versus Group I = 2.1, P < 0.001). Extreme age was also an independentpredictor for postoperative cardiac morbidity, respiratory complications, deep vein thrombosis and stroke (P < 0.01).In this population-based retrospective audit half of all English patients aged over 80 years undergoing emergency colorectal resection died within 1 year of surgery. Advanced age is an independentpredictor of both postoperative morbidity and mortality. These findings demand further research to identify patient groups that are likely to benefit from surgical intervention.