Purpose: This study examines the impact of pre-operative patient transfers between hospitals on 30-, 90-, and 365-day mortality for emergency laparotomy (EL) patients in the Hunter New England Local Health District (HNELHD). All hospitals were within one hour by road transport, yet transfers were frequent. Methodology: A retrospective cohort study analysed 1,320 adult EL cases from 2016–2019, divided into two 2-year cohorts (2016/17 and 2018/19). Propensity-matching accounted for baseline risk factors unaffected by hospital pathways (e.g., age, sex, ASA classification). Data were compared against National Emergency Laparotomy Audit (NELA) benchmarks. Results: Pre-operative transfers occurred in 25.6% of cases, with rates decreasing from 28% in 2016/17 to 22.3% in 2018/19. Transferred patients had significantly higher 30-day mortality (17.5% vs. 10.2%) and 90-day mortality (24.3% vs. 15.8%) compared to non-transferred patients. However, 365-day mortality rates showed no significant difference. Conclusion: Pre-operative transfers for EL patients in HNELHD are linked to increased short-term mortality, reflecting mismatch of resources and patient’s condition at the initial hospital. Many hospitals lack essential features, including 24/7 on-site operating theatre staff, interventional radiology, in-house intensive care, and imaging with on-site reporting. Additionally, insufficiently frequent consultant rostering hinders skills maintenance in gastrointestinal surgery. Addressing these deficiencies through improved facilities and robust on-call systems is crucial. Such changes will reduce transfer dependency. The alternative is a hospital bypass system for abdominal pain patients.