“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,” said Clifford Y. Ko, senior vice president of the ACS Division of Research and Optimal Patient Care. Hospitals that earned American College of Surgeons Emergency General Surgery Verification cut 30-day death rates by 28.8% and shortened stays by 1.31 days for over 21,000 patients, News-Medical reported.
Emergency general surgery treats urgent, life-threatening conditions such as appendicitis, gallbladder disease, and bowel obstruction, often requiring multiple clinical teams to coordinate care with little warning. These patients face some of the highest complication and mortality rates in modern surgery, and previous research has documented rising death rates from emergency surgical conditions among adults younger than 65, particularly in rural areas where access to surgical teams is limited. The new JAMA Surgery analysis suggests that structured hospital verification can measurably reverse these dangerous trends.
In Plain English: The Clinical Takeaway
- Hospitals that met 43 specific emergency surgery standards saw nearly 29% fewer deaths within 30 days of surgery compared to hospitals without the verification.
- Patients at verified hospitals got to the operating room about 10.7 hours faster on average, which matters because delays increase complications like kidney injury.
- The verification process requires ongoing coordination between emergency teams, surgeons, and hospital administration rather than a one-time checklist.
How Verification Changed Speed and Survival at Five Hospitals
The team examined ACS National Surgical Quality Improvement Program records for 21,858 patients who underwent emergency general surgery at 55 hospitals between July 2023 and December 2024. Five hospitals earned verification during this period, while 50 did not.
Using a difference-in-differences analysis—which accounts for trends affecting both groups of hospitals—the team found that verification was associated with a 28.8% lower 30-day postoperative death rate relative to non-verified hospitals. The rate of acute kidney injury, a serious complication that signals both timeliness and quality of care, dropped 29%.
Length of stay fell by 1.31 days on average, a 19.7% reduction. Comparing the five verified hospitals before and after certification revealed that the median interval from admission to operation dropped from 31.9 hours to 21.2 hours—a reduction of 10.7 hours. The share of patients admitted directly to an emergency general surgery service rose from 74.8% to 85.7%, while operations performed after unsuccessful non-surgical treatment dropped from 25.5% to 19%, suggesting more consistent decisions about when to operate.
The 43 Standards Behind the Verification Program
The Emergency General Surgery Verification Program, developed by the ACS in 2022 with the American Association for the Surgery of Trauma, requires hospitals to meet 43 standards covering care pathways and coordination among clinical teams. An ACS review assesses compliance before granting verification.
“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,” Ko said.
Michael Wandling, chief of trauma at The University of Texas in Houston and study co-author, highlighted the vulnerability of this patient group: “This is an important patient population where there is a huge opportunity to improve care, and how hospitals deliver that care can make a big difference.” Patients requiring emergency surgery present with a broad variety of conditions and illness severity, often with minimal time to arrange their care.
Outcomes at Verified Versus Non-Verified Hospitals
| Outcome Measure | Change After Verification | Specific Figures |
|---|---|---|
| 30-day postoperative mortality | 28.8% lower | Relative to non-verified hospitals |
| Acute kidney injury rate | 29% lower | Serious postoperative complication |
| Hospital length of stay | 1.31 days shorter (19.7% reduction) | Average stay after surgery |
| Time from admission to surgery | 10.7 hours faster | Median fell from 31.9 to 21.2 hours |
| Admission to EGS service | Increased from 74.8% to 85.7% | More care under surgical team |
| Surgery after failed non-operative treatment | Fell from 25.5% to 19% | Fewer delayed operations |
What This Means for Rural and Community Hospitals
The study arrives as rural areas face rising death rates from emergency surgical conditions among adults younger than 65. Because the verification program applies to both academic and community hospitals within the U.S. healthcare system, the findings suggest a scalable model for smaller facilities that often lack the infrastructure of large medical centers.
“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,” said Geoffrey Hobika, first author and an ACS clinical scholar in residence and surgery resident at the University of Buffalo.
Study Scope and Potential Biases Disclosed
The analysis reflects early results from only five verified hospitals with a limited follow-up period ending in December 2024. Hospitals chose whether to seek verification and participate in the NSQIP data program, meaning other differences between hospitals or patients may have influenced the findings. The study drew from the ACS National Surgical Quality Improvement Program, and several authors hold ACS-affiliated positions, including Hobika as an ACS clinical scholar in residence.
Warning Signs Demand Urgent Medical Attention
ACS verification improves hospital systems but does not eliminate the inherent risks of emergency surgery. Anyone experiencing severe abdominal pain, persistent vomiting, fever with abdominal tenderness, or signs of bowel obstruction should seek emergency medical care immediately, as delays increase mortality regardless of hospital verification status. Patients with chronic kidney disease face elevated risks of acute kidney injury after emergency surgery and should discuss individual risk factors with their surgical team before any procedure.
References
- Hobika, G. G., et al. (2026). Improving Quality Through the Emergency General Surgery Verification Program. JAMA Surgery. https://jamanetwork.com/journals/jamasurgery/article-abstract/2856095
- Emergency General Surgery Verification Program (developed 2022 with the American Association for the Surgery of the Trauma).
- News-Medical.
- UA.News.
