Purpose: Emergency presentations make up a large proportion of a general surgeon’s workload. Patients who have emergency surgery carry a higher rate of mortality and complications. We aim to review the impact of surgical subspecialisation on patients following Upper Gastrointestinal (UGI) emergency surgery. Methods: A systematic search of Ovid EMBASE, Ovid MEDLINE and Cochrane databases using a predefined search strategy was completed reviewing studies published from the 1st of January 1990 to 27th of August 2023. The study was prospectively registered with PROSPERO (CRD42022359326). Studies were reviewed for the following outcomes: 30-day mortality, in hospital mortality, conversion to open, length of stay, return to theatre and readmission. Results: Of 5181 studies, 24 articles were selected for full text review. Of these seven were eligible and included in this study. There was a statistically significant improvement in 30-day mortality favouring UGI specialist (OR 0.71 (95%CI 0.55-0.92, p=0.009)) and in hospitality mortality (OR 0.29 (95%CI 0.14-0.60, p=0009)). There was a high degree of study heterogeneity in 30-day mortality however a low degree of heterogeneity within in hospital mortality. There was no statistical significance when considering conversion to open, and insufficient data to allow meta-analysis for return to theatre or readmission rates. Conclusion: In emergency UGI surgery there was improved 30-day and in hospital mortality for UGI specialist. Surgeons should therefore consider early involvement of a subspecialist team to improve patient outcomes.