Improving Quality Through the Emergency General Surgery Verification Program

Importance The Emergency General Surgery Verification Program was designed and launched in 2023 by the American College of Surgeons to standardize and improve EGS care through 43 standards that support hospital structure, care processes, and outcome surveillance. Objectives To evaluate the association between EGS verification and hospital length of stay (LOS), acute kidney injury (AKI), and 30-day mortality and to assess whether changes in care processes contribute to effects. Design, Setting, and Participants This quasi-experimental difference-in-differences cohort study with staggered adoption used data from the ACS National Surgical Quality Improvement Program EGS Targeted Dataset. Patients with operatively managed EGS diagnoses from July 1, 2023, through December 31, 2024, at 50 control and 5 verified hospitals were evaluated. Data were analyzed from July 2025 through February 2026. Exposure Hospital EGS verification status. Main Outcomes and Measures Primary outcomes were mean LOS, 30-day mortality rate, and AKI rate. These were calculated adjusted and unadjusted. Average treatment effects on the treated were estimated with hospital-clustered bootstrap standard errors. Results The final cohort included 21 858 patients at 55 hospitals. Median (IQR) patient age was 53.2 (36.5-68.5) years, and 12 366 patients (56.6%) were female. Prior to verification, verified hospitals treated higher-acuity patients and had higher predicted mortality and AKI rates. Verification was associated with absolute reductions in LOS (−1.31 days; 95% CI, −1.95 to −0.67), AKI (−1.23 percentage points; 95% CI, −2.00 to −0.46), and mortality (−1.63 percentage points; 95% CI, −2.55 to −0.71), corresponding to relative reductions of 19.7%, 29.0%, and 28.8%, respectively. These results held after risk adjustment and Bonferroni correction. Verification was also associated with improved care processes, including increased admission to surgical services (74.8% to 85.7%; P < .001), decreased failure of nonoperative management (25.5% to 19.0%; P < .001), and shorter time to operation (−10.7 hours; P < .001). All processes were independently associated with improvements in all 3 primary outcomes. Conclusions and Relevance In this cohort study, early adoption of ACS EGS verification was associated with clinically meaningful reductions in LOS, AKI, and 30-day mortality among participating hospitals. These findings demonstrate the EGS verification likely drives systems-level improvements in emergency surgical care, which may be partially explained by improvements in performance on hospital process measures.