US will face a shortage of nearly 28,000 surgeons by 2038, first nationwide study finds

Vascular surgery, ophthalmology, thoracic surgery, and plastic surgery face the greatest shortfalls, with shortages especially severe in rural areas

American College of Surgeons

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Key Takeaways

• The U.S. is projected to be short nearly 28,000 surgeons by 2038, with the workforce meeting just 84.3% of national need.
• Gaps between surgeon supply and demand are projected to be worse in rural areas.
• The greatest shortfalls are projected in vascular surgery, ophthalmology, thoracic surgery, and plastic surgery. 
• Expanding the number of residencies available can help train more doctors to meet future critical needs.
• The findings will be presented at the American College of Surgeons Clinical Congress 2026 in Washington, Sept. 26-29.

WASHINGTON (September 25, 2026) — The United States will be short nearly 28,000 surgeons by 2038, according to the first unified assessment of the country’s surgical workforce.

The analysis found the surgeon workforce will meet just 84.3% of the country’s need, with the greatest shortfalls in vascular surgery, ophthalmology, thoracic surgery, and plastic surgery, and gaps projected to be worse in rural areas. Concerns about a physician shortage aren’t new, but previous estimates have focused on one or a handful of specialties, leaving no unified picture of how many surgeons the country will need, or where.

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.

“Studies usually look at one specialty at a time, so a shortage looks like that specialty’s problem,” said Fernando Ribeiro Duraes, BA, a medical student at Case Western Reserve University School of Medicine, and lead author on the study. “When you put all 10 specialties together, you can see supply is projected to fall while demand keeps rising, and that the gaps are worse in rural areas. The fixes have to be targeted by specialty and by geography, not incremental.”

In this study, researchers used the Health Workforce Simulation Model (HWSM), a federal model from the U.S. Department of Health and Human Services, and analyzed supply and demand across 10 surgical specialties from 2023 to 2038. They included ophthalmology, plastic surgery, vascular surgery, urology, orthopedics, otolaryngology, neurosurgery, thoracic surgery, general surgery, and colorectal surgery. To create demand projections, they analyzed demographics, health utilization patterns, and physician-to-population ratios.

Study Results

Researchers found that overall, surgeon supply is projected to decline 4.2% from 2023 to 2038, while demand for surgeons will increase by 12.8%. Researchers anticipate this will result in a shortfall of 27,940 surgeons nationally. Across the U.S., the workforce is projected to meet 84.3% of need. Four specialties face critical shortages: vascular surgery (65.8% of need met), ophthalmology (71.8%), thoracic surgery (73.1%), and plastic surgery (74.1%).

Four more specialties face moderate shortages: urology (84.4%), otolaryngology (87.5%), orthopedics (87.9%), and neurosurgery (88.7%). General surgery (91.3%) and colorectal surgery (98.3%) are projected to stay near equilibrium.

These gaps between surgeon supply and demand are also projected to be worse in rural areas. 

The study began close to home. Eliana Ferreira Ribeiro Duraes, MD, PhD, MBA, a plastic surgeon at the Cleveland Clinic, and Fernando Ribeiro Duraes’ mother, started the work by looking at shortages in her own specialty. “I saw [Fernando Ribeiro Duraes] and his colleagues trying to figure out what specialty they wanted,” she said, which prompted a study into wider projections so they can “understand the future and what’s expected to be the landscape in different surgical specialties.” 

For patients, surgical shortages mean longer waits for procedures. Patients may also need to travel longer distances for medical care, especially for people in rural areas who may have to drive hours to be treated.

The findings, researchers say, point to the urgent need to address future surgeon shortages through targeted workforce policies and geography-focused strategies beyond incremental changes. Fernando Ribeiro Duraes specifically points to the proposed bill H.R. 3890, the Resident Physician Shortage Reduction Act, which would raise the number of residency positions, a figure that has not changed since 1997; undoing recent caps placed on federal loan borrowing; and expanding loan forgiveness programs for public service, which can help “encourage physicians to go to these rural areas,” he said. 

Co-authors are Victor F. A. Almeida, MD; John Y. Ha, BA, BS; Emanuella M. Brito, BS; Manoela Dantas, MD; Leonardo De Castro Duraes, MD, PhD; Risal S. Djohan, MD; and Eliana Ferreira Ribeiro Duraes, MD, PhD, MBA.

Disclosures: Authors have no disclosures to report. 

Citation: Ribeiro Duraes F, et al. Projected Surgical Workforce Shortages in the United States: A National Workforce Analysis to 2038. 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.

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About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 95,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons.

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Urban heat islands linked to worse recovery after major surgery

Air conditioning, hydration, and access to cooling centers may need to become part of discharge planning, researchers say

American College of Surgeons

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Key Takeaways 

• Among 697,552 patients undergoing major surgery, each additional 1°C (1.8°F) of urban heat island intensity above a 2.19°C (3.9°F) threshold was associated with 8% higher odds of failing to achieve a “textbook outcome” after surgery. 

• The association was stronger among Black patients and people living in areas with high social vulnerability. In an analysis limited to heat island intensity above the 2.19°C threshold, it was particularly pronounced after cancer-related, emergency, and high cardiac-risk procedures. 

• Researchers say surgical teams may need to ask about home cooling and hydration and connect high-risk patients with community resources before discharge during hot weather. 

• The findings will be presented at the American College of Surgeons Clinical Congress 2026 in Washington, Sept. 26-29. 

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WASHINGTON — Patients living in areas with more intense urban heat were less likely to have an optimal recovery after major surgery, according to new research on nearly 700,000 patients.  

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. 

Above an urban heat island intensity threshold of 2.19°C, or about 3.9°F, each additional 1°C (1.8°F) was associated with 8% higher odds of not achieving a “textbook outcome.” In this study, a textbook outcome required no complications, no readmission, no prolonged hospital stay, and survival for at least 30 days. 

An urban heat island is a developed area that is warmer than its surroundings. Roads, buildings, and other infrastructure absorb and re-emit more heat than natural landscapes, while limited trees and vegetation reduce shade and natural cooling. The temperature difference can vary substantially across neighborhoods within the same city. 

“Heat isn’t only uncomfortable; these data suggest it can have a real impact on surgical recovery,” said Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FSSO, FACS, senior author of the study and professor and chair of the Department of Surgery at The Ohio State University Wexner Medical Center in Columbus, Ohio. “It’s something health care providers need to be aware of. We need to screen for heat exposure and connect at-risk patients with resources.” 

Satellite Data Linked Neighborhood Heat to Surgical Recovery 

The research team developed the Adaptive Spatiotemporal Environmental Thermal Health Exposure Resolution framework, a method for estimating heat exposure in the areas where patients live. The framework used satellite-derived temperature data to link patients’ residential areas with urban heat island intensity, postoperative outcomes, and community characteristics. 

The study included 697,552 patients who underwent major surgery across 3,144 U.S. counties. Their average age was 76 years old. 

Overall, 50.2% of patients achieved a textbook outcome. Across the cohort: 

• 25.2% experienced complications 

• 22.9% had a prolonged hospital stay 

• 14.8% were readmitted 

• 7.1% died within 30 days 

The relationship between heat and suboptimal surgical recovery was stronger among Black patients and residents of communities with high Social Vulnerability Index scores, a composite measure of community-level social and economic vulnerability. 

When the researchers restricted the analysis to urban heat island exposure above 2.19°C, the association was particularly pronounced among patients undergoing cancer-related, emergency, or high cardiac-risk procedures. 

Dr. Pawlik said dehydration and changes in the body’s fluid balance during high heat may be one possible explanation for the stronger association among cardiac patients, who may have less ability to tolerate those stresses.  

Heat Risk May Need to Be Part of Discharge Planning 

The findings suggest that surgical teams may need to consider not only whether a patient is medically ready to leave the hospital, but also whether the patient can recover safely in the environment to which they are returning. 

“Do you have air conditioning in your house? Do you have a fan? Are you going to be able to stay hydrated?” Dr. Pawlik said. He added that questions about heat exposure may need to be increasingly incorporated into discharge planning.  

Access to cooling is not equal. People at higher risk during extreme heat include older adults, people with chronic health conditions or disabilities, people with limited incomes, people experiencing homelessness, and those who do not have access to safe, adequately cooled housing. 

Many communities open cooling centers during periods of extreme heat. Hospitals, patients, and caregivers can use a state-by-state directory of cooling center resources to identify potential local assistance. 

Because the study was observational, it identifies an association and does not establish that residential heat exposure caused the worse outcomes. 

Co-authors are Jethro Z. S. Wang, DMD, MS; Abdulaziz Elemosho, MD; Zheheng Huang, MS; Peng Chen, PhD; Odysseas P. Chatzipanagiotou, MD; Rabia Bega, MBBS, MPH; Yanping Xu, MD, PhD; Lorenza Arena, MD; and Sebastian O. Ekenze, MD, MPH. The authors are affiliated with The Ohio State University in Columbus, Ohio. 

Disclosures: Authors have no disclosures to report.  

Citation: Wang, J, et al. Heat Island-Related Surgical Outcome Burden under Global Warming, Demographic and Adaptation in 3,144 Counties across the United States. 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.  

# # # 

About the American College of Surgeons   

The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 95,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the ACS.   

Follow the ACS on social media: X | Instagram | YouTube | LinkedIn | Facebook 

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Article Title

Heat Island-Related Surgical Outcome Burden under Global Warming, Demographic and Adaptation in 3,144 Counties across the United States

Article Publication Date

25-Sep-2026

 

Prostate cancer surgery and radiation have different long-term effects on urinary, sexual, and survival outcomes 

Surgery was linked to more urinary and sexual side effects, while radiation was associated with certain urinary complications and higher all-cause mortality, national study finds 

American College of Surgeons

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Key Takeaways 

• A national study of more than 20,000 men with prostate cancer compared long-term outcomes after radiation therapy or surgical removal of the prostate, with follow-up of up to 20 years. 

• Men who underwent surgery had higher rates of urinary incontinence and erectile dysfunction. In contrast, men treated with radiation had higher rates of certain urinary complications and higher all-cause mortality, corresponding to a 45% higher rate of death from any cause during follow-up. Researchers could not determine whether treatment contributed to the difference in deaths. 

• Neither treatment was free of long-term consequences, and the authors emphasize that risks, benefits, and side effects of the options should be discussed carefully with patients. 

• The findings will be presented at the American College of Surgeons Clinical Congress 2026 in Washington, Sept. 26-29. 

WASHINGTON — Men with prostate cancer face different long-term risks depending on whether they choose surgery or radiation therapy, with surgery linked to higher rates of urinary incontinence and erectile dysfunction and radiation linked to higher all-cause mortality, according to a national analysis of more than 20,000 men followed for up to 20 years. 

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. 

Prostate cancer is the most common cancer diagnosed in men after skin cancer, with more than 300,000 men expected to be diagnosed this year. For men whose cancer has not spread beyond the prostate, radiation therapy and surgical removal of the prostate, known as radical prostatectomy, are two common treatment options. Choosing between them can involve weighing potential effects on urinary and sexual function and other long-term health outcomes. 

“Treatment for prostate cancer can be life changing for many men, whichever option they choose,” said Jeffrey P. Weiss, MD, PhD, FACS, professor and chair of urology at SUNY Downstate Health Sciences University, and senior author of the abstract. “Both of these treatments can affect urinary and sexual function, though those risks are balanced against the potential for a cure.” 

Researchers analyzed medical records from more than 20,000 men in the TriNetX Research Network who underwent either radiation therapy or radical prostatectomy (including both open and laparoscopic/robotic surgical approaches). Patients were followed for up to 20 years, with a median follow-up of five years. 

Each treatment group included more than 10,000 men and about 17% of patients were Black, making the study population more reflective of the demographics of men diagnosed with prostate cancer today than many earlier studies, noted Juliana Viola, first author of the study and a medical student at SUNY Downstate College of Medicine. Researchers also closely matched patients based on demographic and health characteristics to make the two treatment groups as comparable as possible. 

Study Findings 

• Urinary and sexual side effects: Men who underwent surgery had higher rates of urinary incontinence (28.5% vs. 6.1%) and erectile dysfunction (35% vs. 13.9%). Urinary tract infections (7.4% vs. 4.7%) and obstructive urinary complications (3.6% vs. 2.6%) were also more common after surgery. 

• All-cause mortality: Men treated with radiation had higher all-cause mortality during follow-up than men who underwent surgery (7.8% vs. 6.5%). In a time-to-event analysis, radiation was associated with a 45% higher rate of death from any cause at any given point during follow-up. Because the study measured deaths from any cause, researchers could not determine whether treatment contributed to the difference. 

• Other urinary complications: Men treated with radiation had higher rates of urinary retention (4.4% vs. 4.1%), bladder inflammation (4.3% vs. 3.5%), blood in the urine (11% vs. 10.1%), and inflammation and pain of the prostate gland (0.49% vs. 0.17%). 

While researchers closely matched the two treatment groups, other differences between patients may have influenced the results. As an observational study, the research cannot show that the treatments caused the outcomes. 

“The treatment choice matters in prostate cancer. Patients should understand how the main options differ before they decide,” Dr. Weiss said. “Clinicians need to recognize that these treatments differ in significant ways. The specific risks, benefits, and side effects should be discussed carefully with each patient.” 

The authors noted that future research could examine prostate cancer-specific survival, recurrence, and other long-term outcomes. 

“In prostate cancer, clinicians and patients tend to be driven by avoiding side effects, but we need to better understand the long-term outcomes of each of these treatment options,” Dr. Weiss said. 

Co-authors are Myles Goliger, BS; Robert Adler, BA; Michael Kozlov, BA; Nikolaos Karanikolas, MD, FACS; and Andrew G. Winer, MD, FACS.  

Disclosures: Authors have no disclosures to report.  

Citation: Viola J, et al. Radiation Therapy versus Radical Prostatectomy: A Propensity-Matched Analysis of Mortality and Long-Term Urologic Sequelae. 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.  

# # # 

About the American College of Surgeons   

The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has approximately 95,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the ACS.   

Follow the ACS on social media: X | Instagram | YouTube | LinkedIn | Facebook 

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Data/statistical analysis

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E-scooter trauma admissions nearly double as youngest riders are hurt most severely

Trauma admissions rose 92%; helmet use was documented in only 12%, and nearly two-thirds of injured riders under 16 sustained major injuries

American College of Surgeons

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Key Takeaways 

• E-scooter trauma admissions nearly doubled from 2021 to 2023, increasing 92%, according to a national analysis of more than 10,000 admissions. 

• Helmet use was associated with lower odds of ICU admission but was documented in only 12% of e-scooter trauma admissions. 

• A separate study found that riders under 16 sustained more severe injuries despite lower reported speeds, highlighting potential increased risk for younger riders. 

• The findings will be presented at the American College of Surgeons Clinical Congress 2026 in Washington, Sept. 26-29. 

WASHINGTON — E-scooter trauma admissions nearly doubled from 2021 to 2023, and nearly two-thirds of injured riders under 16 sustained major injuries, according to two national analyses. 

The studies 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. 

Together, the studies provide a national look at the growing burden of e-scooter injuries and the factors that may influence their severity. The findings arrive against an uneven policy backdrop: e-scooter age limits, speed restrictions, and helmet requirements vary by state and locality. 

E-Scooter Trauma Admissions Nearly Double 

E-scooter trauma admissions increased 92% from 2021 to 2023, and helmet use was documented in only a small proportion of cases, according to a national analysis of more than 10,000 trauma admissions. 

Researchers from Howard University Hospital in Washington analyzed national trauma data from 2021-2023, the first years a standardized diagnostic code was available to track e-scooter injuries. Among 10,151 e-scooter trauma admissions: 

• Admissions increased from 2,311 in 2021 to 4,430 in 2023, a 92% increase. E-scooter cases also increased from 0.19% to 0.34% of all trauma admissions in the database. 

• Helmet use was documented in only 12.1% of admissions. 

• Although most injuries were considered minor or moderate (85%), 16.2% of patients required ICU admission and 11.3% underwent an operation. 

• Most patients were male (72.4%) and between the ages of 18 and 64 (72.5%). 

• After adjusting for other factors, patients younger than 18 or 65 and older, those with a rapid heart rate, and those presenting with moderate or severe impairment in consciousness based on the Glasgow Coma Scale had higher odds of ICU admission. Helmet use and obesity were associated with lower odds of ICU admission. 

“It’s important to recognize that e-scooters are not innocuous vehicles; there is danger to them,” said Quyen D. Chu, MD, MBA, FACS, a professor of surgery at Howard University Hospital and senior author of the study. “We need to counsel patients that when they ride these vehicles, they should slow down, obey traffic rules, and wear helmets. Injuries can lead to serious consequences, including a greater than 10% chance of needing an operation.” 

The authors said future research should examine injury patterns and helmet use more closely, including potential differences across communities. 

“We may just be seeing the tip of the iceberg when it comes to understanding trauma related to e-bikes and e-scooters,” said Edward E. Cornwell III, MD, FACS, FCCM, a professor of surgery at Howard University College of Medicine and co-author of the study. “Although this was a national study, injury patterns may differ in urban, suburban, and rural settings. We need to understand this better to prevent more injuries and actively plan for treating these injuries in the trauma bay.” 

Younger Riders Injured More Severely 

In a separate study, younger age was associated with more severe e-scooter injuries among children and adolescents, even though older riders reported traveling at higher speeds, according to research led by a team at Mass General Brigham for Children in Boston. 

Researchers analyzed e-scooter injuries among patients 18 and younger using the National Electronic Injury Surveillance System, examining whether age and reported speed were associated with injury severity. Among 2,185 patients: 

• The average age was 12.8 years, and nearly three-quarters of patients were between the ages of 6 and 15. 

• Patients under 16 sustained major injuries at a significantly higher rate than patients older than 16: 65.6% compared with 53.7%. 

• After adjusting for other factors, older age was associated with three times the odds of sustaining a minor injury and 58% lower odds of sustaining a major injury. 

• Older patients reported traveling at higher average speeds than younger patients (20.3 mph vs. 17.6 mph), suggesting younger age was associated with greater injury severity despite lower reported speeds. 

“A child’s body is still developing, and that—more than the speed of the scooter—is what seems to determine how badly they get hurt,” said Cornelia L. Griggs, MD, MPH, FACS, a pediatric surgeon and surgical critical care specialist at Mass General Brigham for Children, and senior author of the study. 

“An e-scooter is not a toy. We know they’re convenient and many families enjoy them, but a child can get hurt far worse on one than on a regular bike,” she added. 

Co-authors of the national study on e-scooter trauma admissions are Siobhan Nnorom, MD; Nathan B. Lam, BS, MS; Lerone A. Ainsworth, MBBS; Marco Ayad, MD; Valentine Nofong, MBChB; Oluwasegun A. Akinyemi, MD, MSc, PhD; Alexander Evans, MD, MBA, FACS; and Kakra Hughes, MD, PhD, FACS. The authors do not report any relevant disclosures. 

Co-authors of the study on e-scooter injury severity and age are Fiona Beltran, MD; Ikem Nzenwa, MBCHB, MSc; Reagan Collins, MD; and Matthew P. Shaughnessy, MD, MHS. The authors do not report any relevant disclosures. 

Citations: 

Nnorom S, et al. National Trauma Burden of Electric Scooter Injuries Since Standardized ICD-10 Coding. Scientific Forum, American College of Surgeons (ACS) Clinical Congress 2026. 

Beltran F, et al. Severity of Electric Scooter Injury Is Disproportionately Associated with Younger Age. 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.  

# # # 

About the American College of Surgeons   

The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has approximately 95,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the ACS.   

Follow the ACS on social media: X | Instagram | YouTube | LinkedIn | Facebook 

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Deaths linked to treatable emergency surgical conditions are rising in the US

National death rate was about 50% higher in 2020 than in 1999 and 86% higher in rural communities 

American College of Surgeons

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Key Takeaways 

• Death rates associated with three common emergency general surgery conditions, which are rarely fatal when treated promptly, rose about 50% over two decades among U.S. adults ages 18 to 64, according to a national analysis of nearly 20,000 deaths. 

• The difference was greater in rural communities, where the death rate was 86% higher in 2020 than in 1999, compared with 49% higher in urban communities. 

• Researchers examined deaths involving appendicitis, acute cholecystitis, and abdominal wall hernia with obstruction or gangrene, which are common emergency conditions that typically have low death rates when treated promptly. 

• The findings will be presented at the American College of Surgeons Clinical Congress 2026 in Washington, Sept. 26-29. 

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.  

# # # 

About the American College of Surgeons   

The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has approximately 95,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the ACS.   

Follow the ACS on social media: X | Instagram | YouTube | LinkedIn | Facebook 

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Authors have no relevant disclosures to report.

Underweight patients face 92% increased odds of death after emergency general surgery 

Researchers analyzing ACS NSQIP data from more than 334,000 patients find that underweight patients face the highest risk of death, and that those who are both underweight and frail have the worst outcomes, including longer hospital stays 

Reports and Proceedings

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Key Takeaways 

• Patients who are underweight prior to emergency general surgery are at increased risk of death following the surgical procedure.   

• Patients who are both frail and underweight have the worst clinical outcomes after emergency general surgery, with a mortality rate of nearly 10%. 

• Frailty reduces the protective effect of excess weight known as the obesity paradox: compared with normal-weight patients who were not frail, frail patients with obesity had 10% to 65% increased odds of death. 

• These findings will be presented at the American College of Surgeons Clinical Congress 2026 in Washington, Sept. 26-29.   

WASHINGTON — Underweight patients are more likely to die after emergency general surgery than patients who are normal weight or overweight, and patients who are both frail and underweight face an even higher risk of death and other adverse clinical outcomes, according to new research findings. The study drew on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database, which covers more than 334,000 adults who had emergency general surgery between 2019 and 2024. 

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. 

“Our study shows that patients who are both underweight and frail have the worst outcomes. We also saw that frailty reduces the positive impact of the obesity paradox — the finding that patients who are overweight, but not at the extremes of obesity, tend to have better outcomes. That protective effect is lost if a patient is frail,” said lead study author Ellen Cohn, MD, MPH, a third-year general surgery resident at the University of Chicago.  

“What we take away from this study is that risk can be mitigated. We can make real-world changes to body mass index (BMI), and physical therapy can reduce frailty. What is unique about our study is that we were able to look at the impact of BMI and frailty together,” she said. 

Using the ACS NSQIP database, researchers identified all adults, age 18 and older, in the U.S. who had emergency general surgery procedures between 2019 and 2024. ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals. More than 600 hospitals participate in the ACS NSQIP adult program, which began enrolling private sector hospitals beginning in 2004.  

The ACS NSQIP data allowed researchers to evaluate the relationship between BMI and level of frailty on outcomes including death, hospital length of stay, and readmission rates 30 days after initial admission, as well as the interaction between BMI and frailty and their combined associated risk on these outcomes. Frailty was assessed on a scale with values from one to five, with one indicating patients who had one comorbidity such as diabetes or chronic obstructive pulmonary disease and five indicating patients who had five diseases and were severely frail.  

Study Results 

• Among 334,278 patients included in the analysis, 37.6% were frail, more than one in three. 

• After adjusting for clinical factors, underweight patients had the highest risk of death, with 92% increased odds compared with normal-weight, non-frail patients. In contrast, obese patients had lower odds of death than normal-weight patients: 43% lower at a BMI of 30.0–34.9 and 27% lower at 35.0–39.9. At a BMI of 40 or higher, there was no significant difference. 

• Frailty alone was associated with 59% increased odds of death. 

• Compared to patients who were normal weight and not frail, those who were both underweight and frail had the worst outcomes across all measures: 9.8% mortality, 15.8% readmission rates, an average length of stay of 8.2 days, and an 88.5% discharge-to-home rate. For comparison, non-frail patients had a discharge to home rate of 96.9% and normal weight patients 90.3%. 

• Frailty reduced the protective effect of obesity on mortality. People who were both frail and obese faced 22% increased odds of death, whereas those who were obese but not frail remained 7% less likely to die after emergency general surgery. 

“While the focus of our study was on underweight and frail patients, we were surprised to find that obese patients did better,” said study co-author Justin S. Hatchimonji, MD, assistant professor of surgery in the section of trauma and acute care surgery at the University of Chicago.  

“I think recognizing the importance of not only underweight status, but also frailty, helps emergency general surgeons plan for postoperative outcomes and think about how to best manage these patients over the long term.” 

Dr. Cohn said the findings can be used to improve postoperative outcomes regardless of frailty scores.  

“Thinking about older patients, it’s important to focus on what we can affect: nutrition, making sure protein goals are met, bone health, and vitamins,” she said. “Keeping patients healthy that way can have a bigger impact on outcomes than the other comorbidities that make up the frailty score. We know that you can change underweight status and as a result get a better outcome.” 

A limitation of the study is that a large database study cannot prove cause and effect, only an association.  

Co-authors are Hans Strobl, MD; Phillip Dowzicky, MD, FACS; Abid D. Khan, MD, FACS; and Diane N. Haddad, MD. 

Disclosures: Authors have no disclosures to report.  

Citation: Cohn E, et al. The Synergistic Risk of Underweight Status and Frailty in Emergency General Surgery. 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.  

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About the American College of Surgeons 

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 95,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons. 

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Method of Research

Data/statistical analysis

Subject of Research

People

COI Statement

Authors have no disclosures to report.