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RESEARCH ARTICLE

Time-to-operation and hospital mortality in emergency general surgery: Evidence from 6.8 million admissions supporting dedicated emergency general surgery services

Abbas Smiley1 ,  Rifat Latifi2*
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1 Department of Medicine, School of Medicine, University of Rochester, Rochester, New York, United States of America
2 Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
STI, 0419 https://doi.org/10.36922/STI0419
Received: 1 December 2025 | Revised: 4 June 2026 | Accepted: 9 June 2026 | Published online: 21 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Delays of time-to-operation (TTO) in emergency general surgery (EGS) are common, but large-scale evidence on the impact of this delay on hospital mortality remains limited.

Objective: To evaluate the association between TTO and in-hospital mortality in EGS on both adult (18–64 years) and elderly (≥65 years) patients.

Methods: This retrospective study analyzed 6,805,380 EGS admissions from the National Inpatient Sample (2005–2014). Primary diagnoses were defined according to the American Association for the Surgery of Trauma (AAST) EGS classification. The primary exposure was TTO, defined as the number of days between hospital admission and the first operative intervention. The primary outcome was in-hospital mortality. Multivariable logistic regression models were adjusted for demographic characteristics, comorbidities, and frailty using a modified 5-item frailty index.

Results: A total of 6,805,380 patients were analyzed. Overall mortality was 1.7% (elderly: 4.2% vs. adults: 0.7%). Each day of delay increased mortality odds by 13.5% in adults with no comorbidities (odds ratio [OR] 1.135, 95% confidence interval [CI]: 1.12–1.15) and 9.3% in the elderly with no comorbidities (OR: 1.093, 95% CI: 1.08–1.11). Frailty amplified the risk of mortality (OR: 1.2–1.5, while surgery served as a protective factor (OR: 0.5–0.7 vs. non-operative management).

Conclusion: TTO is a modifiable mortality predictor in EGS in both adults and elderly patients. These results further support the recent initiative by the American College of Surgeons/AAST to establish dedicated EGS services, which reduces delays in TTO. Future prospective studies are needed to validate these findings.

Keywords
Emergency general surgery
Time-to-operation
Mortality
Frailty
National Inpatient Sample
Funding
This study was supported by a donation awarded to the Department of Surgery Clinical Research Unit of Westchester Medical Center through the Westchester Medical Center Foundation, Valhalla, New York, United States.
Conflict of interest
The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.
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