Older adults undergoing emergency surgery for gastrointestinal cancer often face complicated recovery trajectories that impact care planning.

• Among 15,398 patients, 13.2% experienced sustained high dependency beyond home, linked to advanced disease and frailty.
• Factors like stage IV disease (ARR 2.39) and frailty (ARR 2.58) significantly increase the risk of extended hospital stay and institutional dependence.

Understanding these risk factors can help surgeons better stratify patients and optimize postoperative care.

• Major complications and ICU admissions further elevate the likelihood of prolonged recovery.