Higher operative-to-nonoperative management ratios in emergency general surgery are linked to better home discharge rates for older patients.

• Older adults treated at hospitals in the highest tertile of the operative-to-nonoperative ratio had 10% higher odds of being discharged home (OR 1.10, 95% CI: 1.06-1.14).
• Traditional metrics of morbidity and mortality may not capture what matters most to older patients, such as their ability to return home post-surgery.

Surgeons may want to consider the operative-to-nonoperative management ratio as a quality indicator when treating older adults in emergency settings.