Medical records of equine after-hours admissions from 1998 to 2007 are reviewed. Data extracted from the medical records included signalment, reason for admission, pre-admission treatment, clinical presentation, procedures performed, final diagnoses, complications occurring in hospital, length of stay and outcome. Eight hundred and twenty after-hours admissions were available of which 75% were classified as emergencies. Most horses originated from Gauteng province (82%), with Thoroughbred, Arabian, and Warmbloods representing 46%, 10% and 7% of horses. Horses had a median age of 7 years and were predominantly male (60%). Gastrointestinal (64%) and musculoskeletal (19%) disorders were the primary reasons for admission. Anti-inflammatories, sedation and antibiotics were given in 51%, 20% and 15% of cases respectively prior to referral. On admission, 23% of horses had surgical intervention. Intravenous catheterisation (64%), rectal examination (61%), nasogastric intubation (56%), abdominocentesis (33%) and ultrasonography (19%) were the procedures performed most frequently. Surgical and medical colics constituted 28% and 27% respectively of the overall diagnoses, while piroplasmosis was diagnosed in 5% of horses. Post-admission complications occurred in <2% of horses. The median length of stay was 4 days (95% CI: 1 to 21 days). Overall survival to discharge was 74%. This study demonstrates that the majority of after-hours equine admissions to a university referral hospital required medical intervention and were mostly due to gastrointestinal disorders. Information obtained from this study can be used in emergency referral planning.