Patients who bypass their nearest surgical hospitals for urgent procedures may face worse clinical outcomes.

• Bypass is linked to higher odds of disease progression (adjusted odds ratio 1.22).
• Complications increase by 12% (aor 1.12) and length of stay by 20% (aor 1.20) for bypass patients.

Understanding these risks is essential for optimizing patient selection and encouraging local interventions.

• Mortality risk remains unchanged (aor 1.25).