Introduction EGS patients have higher mortality than elective surgical inpatients. Few studies have investigated changes in EGS-associated mortality over time or explored mortality rates post discharge. A comprehensive, population-based analysis of mortality rates in EGS patients, over a 20-year timeframe was therefore conducted. Methods This was a cross-sectional study of all adult EGS admissions in Scotland between 1996 and 2015. Data were obtained from national records. Co-morbidities were defined by Charlson co-morbidity index and operations were coded by OPCS4 classifications. Linear and multivariate logistic regression models were used to evaluate changes over time. Results Among 1 450 296 patients, the overall inpatient, 30-day, 90-day and one-year mortality rates were 1.8%, 3.8%, 6.4% and 12.5%, respectively. Mortality was influenced by age at admission, co-morbidity, operation performed and date of admission (all p<0.0001) and improved with time on subgroup analysis by age, co-morbidity and operations. Medium-term mortality was high: The one-year mortality rate in patients >75 years was 35.6%. One-year mortality in highly co-morbid patients decreased from 75% to 57% over the timeframe of the study (p<0.0001). Conclusion EGS in Scotland has experienced a significant reduction in mortality over time. This analysis of medium-term mortality after EGS admission demonstrates strikingly high rates and, as such, post-discharge management is more than currently appreciated.