Purpose: Following the declaration of the COVID-19 pandemic by the World Health Organisation, many measures to contain its spread were applied in Australia, including the cancellation and postponement of elective procedures. This study aims to explore the impact of these delays to elective surgery on emergency department (ED) presentations and post-operative outcomes. Method: This was a single-centre retrospective cohort study comparing waitlisted elective general surgical patients presenting to ED between 2021 to 2023 to a pre-COVID cohort presenting between 2017 to 2019. Primary outcome was incidence and proportion of ED presentations for waitlisted patients, with secondary outcomes of emergency surgical intervention and post-operative morbidity. SPSS was used for Pearson Chi-square testing of categorical variables and t-testing of continuous variables. Results: No significant difference in incidence of related ED presentations was found between the two groups (22.1% v 21.4%, p = 0.610). A significant increase in average waitlist time was seen in the post-COVID period, with delays to procedures for 65.8% of patients compared to 19.1% pre-COVID (<0.001). Average waitlist time for category 1 & 2 procedures in the post-COVID period was notably higher than the recommended category wait-time (category 1, 84.4 +/- 100.0 days; category 2, 195.5 +/- 146.4 days). The readmission rate within 30 days of surgery was significantly higher in the post-COVID period (p<0.001). Conclusion: Whilst an increase in incidence of emergency presentations for waitlisted elective general surgical patients was not seen in our study, significant delays to surgery and an increase in post-operative morbidity were apparent in the post-COVID period.