Impact of Geriatric Surgery Verification Program Implementation on Vulnerability Assessment Rates: A Multicenter Retrospective Cohort Study

BACKGROUND: Preoperative geriatric vulnerability assessment is inconsistently performed despite the elevated risk of adverse outcomes among older surgical patients. We evaluated whether implementation of the American College of Surgeons Geriatric Surgery Verification (GSV) Program was associated with increased vulnerability assessment across a multicenter health system. STUDY DESIGN: This multicenter retrospective cohort study included 6,631 patients aged ≥75 years undergoing elective inpatient surgery at 20 Kaiser Permanente Northern California hospitals from July 2022 through December 2025. GSV implementation was defined by each hospital's site visit; the preceding 15-month adoption period was excluded from the primary analysis. Geriatric vulnerability assessment, defined as documentation of ≥1 standardized screen component, was compared pre- and post-GSV using logistic regression with marginal standardization and adjustment for secular trends across 14 calendar quarters. RESULTS: Among 4,569 pre-GSV and 2,062 post-GSV patients, unadjusted assessment rates were 40.2% and 52.8%, respectively (p<0.0001). Adjusted rates were 43.4% (95% CI 41.9%-44.8%) pre-GSV and 47.3% (95% CI 45.2%-49.4%) post-GSV, an adjusted difference of 4.0 percentage points (95% CI 1.3-6.6; p=0.0037). A sensitivity analysis classifying the adoption period as post-GSV yielded a 7.2-percentage-point adjusted difference (95% CI 4.9-9.4; p<0.001). Unadjusted service-level increases were largest in cardiac and vascular surgery. CONCLUSIONS: GSV Program implementation was associated with a modest increase in geriatric vulnerability assessment across a multicenter health system. Variation across surgical services identifies opportunities to address service-level barriers to implementation.