Objective: This study aimed to retrospectively analyze the surgical intervention needs and outcomes of patients aged >65 years who were admitted from the emergency department to the general surgery ward due to gastrointestinal complaints. This study further explores the impact of age and comorbidities on surgical outcomes in this population. Material and Methods: A total of 525 patients aged 65 years and older who presented with gastrointestinal symptoms were included in this retrospective observational study conducted at İzmir Katip Çelebi University Atatürk Training and Research Hospital. Data on demographic characteristics, presenting complaints, diagnoses, surgical interventions, and outcomes were collected and analyzed using IBM SPSS Statistics 26.0. Results: The mean age of the study population was 79.72±9.25 years, and 45.1% were female. The most common presenting complaint was abdominal pain (54.7%), and the most frequent diagnoses were ileus (25.0%), acute cholecystitis (21.9%), and perforation (10.1%). Emergency surgery was required in 35.6% of the patients. The present study found a statistically significant association between higher mortality rates and diagnoses such as perforation, mesenteric ischemia, and trauma. Mortality was also significantly higher among patients with severe comorbidities. Conclusion: Elderly patients requiring emergency surgical intervention are at high risk of mortality, particularly in the presence of specific diagnoses and comorbidities. These findings highlight the need for careful surgical decision-making and the adoption of multidisciplinary approaches in the management of elderly patients to improve outcomes. Further research is recommended to optimize perioperative care in this vulnerable population.