Purpose <p>Hernia repairs have differences in outcomes based on hernia type. Information regarding hernia burden in the emergency setting is lacking. Among older adults, who have the greatest prevalence of hernia and the need for emergent repair, little data on the impact of multimorbidity on outcomes exist. We aim to define the burden of emergency hernia on hospitals and to compare outcomes of older adults with and without multimorbidity.</p> Methods <p>This was a nationwide retrospective cohort study of Medicare beneficiaries admitted emergently from 2015–2018 with a principal diagnosis of an umbilical, ventral, parastomal, femoral, or inguinal hernia. The primary outcome was all-cause inpatient mortality. Multivariable logistic regression was performed.</p> Results <p>Among 47,687 hospitalized patients, there were 4,612 (9.7%) umbilical, 17,707 (37.1%) ventral, 2,486 (5.2%) parastomal, 3,754 (7.9%) femoral, and 15,138 (31.7%) inguinal hernias. Multimorbidity was common (<i>n</i> = 24,393, 51.2%). Multimorbid patients had significantly higher rates of inpatient mortality (4.1% vs 1.1%), intensive care needs (48.6% vs 22.7%), discharge to a skilled nursing facility (SNF) (23.9% vs 11.7%), and 30-day readmission (22.0% vs 13.9%) than non-multimorbid patients. After adjustment, multimorbid patients had higher odds of death during index hospitalization (odds ratio = 1.98, CI: 1.53–2.56), intensive care needs (1.89, 1.74–2.06), and discharge to a SNF (1.52, 1.35–1.72) than non-multimorbid patients. Outcomes varied significantly based on hernia type.</p> Conclusions <p>We define rates and outcomes of emergency hernia hospitalization in older adults across different hernia types and multimorbidity status. Multimorbid older adults hospitalized for ventral hernias had greatest risk of inpatient death. These data will permit improved patient counseling and shared-decision making for older patients admitted for emergency hernias across hernia types.</p>