Obesity dramatically raises mortality risk in acute abdominal surgery patients, making targeted interventions critical.

• Overall obesity-related mortality rose from 2.05 to 5.5 per million (1999-2020), with a notable jump after 2018.
• Women have higher mortality rates, but men show faster increases in the obesity group.

Awareness of racial disparities is crucial, as non-Hispanic American Indians show the highest mortality rates.

• The South saw the steepest regional increase, indicating a need for localized surgical strategies.