A national study presented at the 2026 American College of Surgeons Clinical Congress reveals that mortality rates for three common, treatable emergency surgical conditions—appendicitis, acute cholecystitis, and an abdominal wall hernia with obstruction or gangrene—rose approximately 50% among U.S. adults aged 18 to 64 between 1999 and 2020. According to a national analysis of nearly 20,000 deaths, these mortality rates increased nearly twice as fast in rural communities as they did in urban areas.
The research, which utilized data from the CDC WONDER Multiple Cause of Death database, evaluated 19,601 deaths. While these specific conditions are typically associated with low mortality when patients receive prompt treatment, the study indicates that more working-age adults are dying with these diagnoses than two decades ago.
Study Scope and Methodology
The researchers noted several key parameters regarding the data. The analyzed conditions were documented on death certificates as contributing factors, but the study could not establish that these conditions were the primary cause of death. The analysis also relied on unadjusted death rates, meaning the findings may not account for shifts in demographic characteristics or population age structures over the two-decade period. The study also did not separately assess the impact of the COVID-19 pandemic on mortality rates during the analyzed years.
Expert Perspective on Rising Mortality
Vishnu Mani, MBBS, FACS, the study’s first author and vice chair of surgery for OSF HealthCare, noted the urgency of the findings. These are conditions surgeons treat every day, and patients usually do well when they reach the operating room in time,
Mani stated. 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.
Senior author Faran Bokhari, MD, MBA, FACS, FCCP, emphasized that the trend is widespread rather than isolated. 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,
Bokhari said. Researchers concluded that further investigation is required to determine whether factors such as delays in surgical access, workforce capacity, or underlying health issues are driving the increase.
