A large national study compared four frailty scoring systems for predicting in-hospital mortality and complications among adult patients undergoing emergency general surgery. The Hospital Frailty Risk Score (HFRS) emerged as the most accurate tool, identifying frail patients who had significantly higher risks of mortality and complications. Frail patients were generally older, with higher comorbidity rates and longer hospital stays. The study endorsed the use of frailty assessment to guide clinical decision-making and resource allocation in emergency surgical settings, particularly for older adults.