<p>Immigrants to Canada face unique barriers that result in them accessing publicly funded healthcare services differently than non-immigrants. These barriers are particularly critical in the context of Emergency General Surgery (EGS) where timely access to healthcare is essential for better health outcomes. This study compares preoperative healthcare utilization between immigrants undergoing EGS with non-immigrants. EGS procedures in British Columbia between 2013 and 2021 were analyzed using population-based linked immigration, physician billing, and hospital discharge summary data. Preoperative primary care visits, specialist consults, imaging, and emergency department (ED) visits in the one-year period preceding the EGS were compared between immigrants with non-immigrants. Sub-analyses examined years since immigration and ethnic minority status. Of 77,937 EGS procedures, immigrants accounted for 14.6%. Immigrants had fewer pre-operative primary care visits (RR: 0.94, 95%CI: 0.92-0.96), specialist consults (RR: 0.88, 95%CI: 0.85-0.91), imaging services (RR: 0.96, 95%CI: 0.93-0.99), and ED visits (RR: 0.70, 95%CI: 0.68-0.72). Within the immigrant cohort, fewer primary care and ED visits were observed among the newest immigrants and among ethnic minorities. Immigrants accessed fewer healthcare services in the period preceding their EGS. Differences were most pronounced among new immigrants and immigrants from culturally-diverse countries who may be unfamiliar with the structure or processes for accessing healthcare services. Policy interventions are needed to prospectively link immigrants at highest risk of EGS with appropriate health services.</p>