WASHINGTON — Death rates associated with three common, treatable emergency general surgery conditions rose about 50% among U.S. adults ages 18 to 64 between 1999 and 2020 — and rose nearly twice as fast in rural communities as in urban ones, according to a national analysis of nearly 20,000 deaths.
The research will be presented at the American College of Surgeons (ACS) Clinical Congress 2026 in Washington, Sept. 26-29, where thousands of surgeons will convene to advance surgical quality, patient safety, and access to care.
“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 Details
Led by a team at OSF Saint Francis Medical Center, researchers analyzed data from the CDC WONDER Multiple Cause of Death database. The analysis included adults ages 18 to 64 whose deaths were associated with appendicitis, acute cholecystitis, or an abdominal wall hernia with obstruction or gangrene. These common emergency general surgery conditions generally have low mortality when treated promptly.
The conditions were documented on death certificates as contributing to the death but were not necessarily the primary cause. As a result, the analysis could not establish that the emergency surgical condition itself caused the death.
Among 19,601 deaths associated with the three emergency surgical conditions included in the analysis:
- The national death rate was about 50% higher in 2020 than in 1999, increasing from 0.4 to 0.6 deaths per 100,000 people. In rural communities, the rate was 86% higher in 2020 than in 1999, compared with 49% higher in urban communities.
- More recent data showed that the number of deaths remained elevated, increasing from 938 in 2021 to 973 in 2024, a 3.7% increase. Deaths increased 6.1% in rural communities compared with 3.2% in metropolitan communities. These figures reflect total deaths rather than population-based death rates.
- Death rates were consistently higher among males than females and increased with age, peaking among adults ages 55 to 64.
The study was not designed to determine what caused the increase or whether timely access to emergency surgical care contributed to the findings. Additionally, the analysis used unadjusted death rates, meaning the findings may not account for changes in the age or other characteristics of the population over time. The COVID-19 pandemic may also have influenced mortality during some years included in the analysis, but the study did not separately evaluate its impact.
Further research is needed to understand what may be driving the increase, including whether timely access to emergency surgical care, workforce availability, underlying health conditions, or other factors may have contributed to the findings.
“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 at OSF HealthCare, trauma medical director, 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.”
Co-authors are Samreen Rizwan Shaikh, MD; Arshpreet Kaur, MBBS, MS; Shugofta Aziz, MBBS; and Anoosh Farooqui, MBBS, MPH.
Disclosures: Authors have no relevant disclosures to report.
Citation: Mani V, et al. Failure of Timely Surgical Access? Rising Mortality from Treatable Emergency Conditions in U.S. Working-Age Adults — a CDC WONDER Analysis 1999-2020; 2018-2024. Scientific Forum, American College of Surgeons (ACS) Clinical Congress 2026.
Note: Research abstracts presented at the ACS Clinical Congress Scientific Forum are reviewed and selected by a program committee but are not yet peer reviewed.
