A national study revealed a 50% increase in mortality from common emergency surgical conditions, with rural communities experiencing the steepest rise.
RT’s Three Key Takeaways:
- Rising Mortality Rates: Death rates associated with three common, treatable emergency general surgery conditions rose approximately 50% among US adults aged 18 to 64 between 1999 and 2020.
- Disproportionate Rural Impact: Mortality rates linked to these emergency surgical conditions increased nearly twice as fast in rural communities compared to urban areas.
- Need for Further Investigation: Researchers emphasize that further study is required to determine whether delays in timely surgical access, healthcare workforce shortages, or underlying health conditions are contributing to the rise.
Death rates associated with three common, treatable emergency general surgery conditions rose about 50% among US adults ages 18 to 64 between 1999 and 2020, and increased nearly twice as fast in rural communities as in urban ones, according to a national analysis of nearly 20,000 deaths.
The research, presented at the American College of Surgeons (ACS) Clinical Congress 2026, examined data from the CDC WONDER Multiple Cause of Death database. The study evaluated 19,601 deaths among adults ages 18 to 64 associated with appendicitis, acute cholecystitis, or an abdominal wall hernia with obstruction or gangrene. These emergency general surgery conditions typically carry low mortality when treated promptly.
“These are conditions surgeons treat every day, and patients usually do well when they reach the operating room in time,” said Vishnu Mani, MBBS, FACS, first author of the abstract, emergency general surgery medical director, and vice chair of surgery for OSF HealthCare in Peoria, Illinois. “What we found is that more working-age adults are dying with these conditions than two decades ago, which raises important questions about whether patients are getting to surgical care in time, especially in rural communities, and whether workforce shortages or other pressures are contributing.”
Study Parameters and Findings
According to the study details reported by the ACS, the conditions were documented on death certificates as contributing factors to death but were not necessarily the primary cause. Consequently, the analysis could not establish that the emergency surgical conditions themselves caused the deaths.
The study was not designed to identify what caused the increase or whether timely access to emergency surgical interventions influenced the outcomes, the authors noted. Furthermore, the analysis utilized unadjusted death rates, which means the findings may not account for changes over time in the age structure or other demographic characteristics of the population. While the COVID-19 pandemic may have influenced mortality during some of the analyzed years, the study did not separately assess its impact.
“We saw increases across sex, age, region, and geography, which tells us this is not one group of patients or one corner of the country,” said Faran Bokhari, MD, MBA, FACS, FCCP, chair of surgery, trauma medical director at OSF HealthCare, and senior author of the abstract. “The next question is why. We need to understand whether gaps in timely access to surgical care, workforce capacity, underlying health, or other factors are driving what we are seeing. That is exactly the kind of question the surgical community should be taking on together.”
