Background: Delays in emergency abdominal surgery increase complications and mortality. Hospitals have introduced integrated pathways linking radiology, laboratory testing, anesthesia, and operating room access to improve timeliness and outcomes. Objective: To synthesize evidence on integrated emergency abdominal surgery pathways and their associations with time to intervention and postoperative complications. Methods: We conducted a systematic review following PRISMA. PubMed Central was searched for full-text studies evaluating integrated or pathway-based models for emergency abdominal surgery (emergency laparotomy bundles, acute care surgery services, ERAS-type emergency pathways, and diagnostic, surgical pathways such as appendicitis pathways). Eligible designs included randomized trials, prospective audits, and cohort studies reporting timeliness outcomes and, or clinical outcomes. Results: Eleven original studies were included. Bundle-based emergency laparotomy pathways were associated with lower risk-adjusted 30-day mortality in multicenter quality improvement work and improved longer-term outcomes in standardized management programs. Acute care surgery models and organizational pathways that included dedicated emergency resources were consistently linked to shorter delays and improved efficiency metrics. Several studies reported reductions in postoperative complications and, or length of stay after pathway implementation. Conclusion: Integrated pathways that coordinate radiology, laboratory workflows, anesthesia readiness, and surgical access are associated with improved timeliness, and many studies report fewer complications and, or lower mortality. Heterogeneity in pathway components and outcome definitions limits pooling; future multicenter studies should standardize timeliness metrics and complication reporting.