Older adults with gastrointestinal cancer show varied 12-month recovery trajectories post-emergency surgery, with significant implications for patient counseling and planning.

• In a cohort of 15,398 patients, 7.2% had prolonged recovery and 13.2% faced sustained institutional dependence after surgery.
• Key risk factors for prolonged recovery included stage IV disease (adjusted relative risk [ARR] 1.92), a Charlson Comorbidity Index greater than 2 (ARR 1.79), and frailty (ARR 4.50).
• Major postoperative complications and extended ICU stays heightened these risks.

Surgeons should assess these factors to better predict recovery trajectories and tailor postoperative care accordingly.