Becher R, et al. - As Agency of Healthcare Research and Quality, Center for Medicare and Medicaid Services, and National Quality Forum use expected performance rates for various outcome metrics as the hallmark of hospital quality indicators, researchers examined hospital variation in mortality after emergency general surgery (EGS) operations and compared outlier hospitals regarding their characteristics. Using data from the California State Inpatient Database (2010–2011), they included 140,333 patients who underwent one of eight common EGS operations from 220 hospitals. The analysis revealed significant hospital variation in standardized mortality after EGS operations. Significant excess mortality was observed high standardized mortality ratio (SMR) outliers, while superior EGS survival was observed in low SMR outliers. The wide gap between underperforming and overperforming outlier institutions could not be explained by common hospital-level characteristics. These findings suggest the possible utility of assessing SMR in appraising EGS performance across hospitals. Further research is recommended to recognize and determine the hospital processes of care which translate into optimal EGS outcomes.