Emergency surgery verification program linked to lower death rates and shorter hospital stays

Patients who underwent emergency general surgery at hospitals that earned a new American College of Surgeons verification had lower 30-day death rates and shorter hospital stays after their hospitals earned the designation, according to an analysis published in JAMA Surgery. The study included 21,858 patients treated at 55 hospitals between July 2023 and December 2024, and it compared outcomes at the five hospitals that became verified during the study period with outcomes at 50 hospitals that did not. Relative to the changes seen at unverified hospitals, verification was associated with a 28.8% lower 30-day postoperative death rate, a 29% lower rate of acute kidney injury, and hospital stays that averaged 1.31 fewer days, a 19.7% reduction.

The findings come from a difference-in-differences analysis, a statistical approach that helps account for trends affecting both groups of hospitals. Rather than simply measuring whether outcomes improved after verification, the researchers examined whether patient outcomes changed after the five hospitals earned verification and compared those changes with outcomes over the same period at the 50 hospitals that did not earn verification.

Emergency general surgery treats urgent and often life-threatening conditions such as appendicitis, gallbladder disease, and bowel obstruction. Patients often need surgery with little warning, and their care requires several clinical teams to work together. These patients face some of the highest complication and mortality rates among surgical patients, and previous research has found rising death rates from some emergency surgical conditions among adults younger than 65, particularly in rural areas.

The Emergency General Surgery Verification Program, known as EGS-VP, was developed by the American College of Surgeons in 2022 with the American Association for the Surgery of Trauma. It provides hospitals with standards and infrastructure to manage this high-risk patient population with the aim of improving clinical and financial outcomes. Hospitals seeking verification must meet 43 standards, including requirements for care pathways and coordination among clinical teams, and an ACS review assesses whether they meet those standards.

In a separate before-and-after analysis of the verified hospitals, the researchers also observed improvements in how patients received care. Median time from admission to surgery fell from 31.9 hours to 21.2 hours, a decrease of 10.7 hours. The share of patients admitted to an emergency general surgery service rose from 74.8% to 85.7%, meaning more patients were cared for under a dedicated surgical team. The share of patients who underwent surgery after an unsuccessful attempt to treat their condition without an operation fell from 25.5% to 19%, a measure the authors noted may reflect more consistent decisions about when to operate.

The acute kidney injury result deserves particular attention because the condition serves as a measure of both timeliness and quality of surgical care.

Study co-author Michael Wandling, MD, MS, FACS, chief of trauma at The University of Texas in Houston, emphasized the difficulty of caring for this population. “Emergency surgery patients arrive with a wide range of conditions and levels of illness, often with little time to plan their care,” he said.

Senior author Clifford Y. Ko, MD, MS, MSHS, FACS, senior vice president of the ACS Division of Research and Optimal Patient Care, placed the results in a longer context. “Emergency surgery can happen to anyone, and data from the past two decades has shown us that these patients face some of the worst outcomes among surgical patients,” he said. “These findings show, for the first time in emergency general surgery, what we’ve seen for our other quality programs: that the quality and timeliness of surgical care can be dramatically improved through the structured framework provided through ACS verification, whether it’s at an academic or community hospital.”

First author Geoffrey Hobika, MD, an ACS clinical scholar in residence and surgery resident at the University of Buffalo in Buffalo, New York, framed the work as a strategy with implications beyond mortality. “This study shows that implementing emergency general surgery verification was a successful strategy for improving both the speed and quality of care for patients undergoing emergency general surgery, which are important metrics also tied to reduced hospital costs,” he said. “The next step is to see whether those improvements continue among verified hospitals and as more hospitals receive verification.”

The study reflects early results from five verified hospitals and a limited follow-up period, and the authors acknowledge important limitations. Hospitals chose whether to seek verification and to participate in the NSQIP data program, and other differences between hospitals or patients may have influenced the findings.

Subject of Research: Outcomes of emergency general surgery patients at hospitals with and without American College of Surgeons verification

Article Title: American College of Surgeons emergency surgery verification linked to lower death rates, shorter hospital stays

Article References: American College of Surgeons emergency surgery verification linked to lower death rates, shorter hospital stays. Original publication (Bibliographic details unavailable.)

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Keywords: emergency general surgery, American College of Surgeons, verification program, 30-day mortality, hospital length of stay, acute kidney injury, difference-in-differences analysis, NSQIP, JAMA Surgery, surgical quality improvement, time to surgery, care pathways