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Background: American College of Surgeons (ACS) trauma center verification has demonstrated improved outcomes at individual centers, but its impact on statewide Trauma Quality Improvement Program (TQIP) Collaboratives is unknown. A statewide TQIP Collaborative, founded in 2011, noted underperformance in six of eight patient cohorts identified in the TQIP Collaborative report. We hypothesized that requiring ACS verification for level I and II trauma centers would result in improved outcomes for the state collaborative., Methods: The ACS verification requirement was tied to ongoing Trauma Commission funding. Trauma centers were required to apply for an ACS consultative visit by 2017 and were given until 2023 to achieve ACS verification. The effect of this intervention was measured in the number of centers achieving verification and in the performance of the TQIP Collaborative semiannual reports., Results: In 2015, only 1 of 15 (7%) trauma centers were ACS verified, and 4 had undergone consultative visits. By 2023, 11 of 12 (92%) trauma centers achieved ACS verification. Following this intervention, the observed-to-expected odds ratio for all-patient morbidity and mortality improved from 1.60 to 1.17, and variation among patient-specific cohorts narrowed from 0.97-1.82 to 0.96-1.48 (Figure 2). Performance in all six underperforming patient-specific cohorts improved over the study period., Conclusion: ACS verification for level I and II trauma centers improves TQIP Collaborative performance. Statewide Collaboratives should consider ACS verification as a requirement for participation., Level of Evidence: Economic and Value-Based Evaluations, Level III., (Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.)

Competing Interests: Disclosure and Conflicts of Interest Statement: Zachary J Grady is funded by the NIH NIGMS T32 training grant (GM095442-13). The funding body had no influence on study design, data analysis, or manuscript production. The remaining authors declare no conflicts of interest. All JTACS Disclosure forms have been supplied and are provided as supplemental digital content ( http://links.lww.com/TA/D564 ).

Background: Blunt traumatic abdominal wall hernias (TAWH) occur in approximately 15,000 patients per year. Limited data are available to guide the timing of surgical intervention or the feasibility of nonoperative management., Methods: A retrospective study of patients presenting with blunt TAWH from January 2012 through December 2018 was conducted. Patient demographic, surgical, and outcomes data were collected from 20 institutions through the Western Trauma Association Multicenter Trials Committee., Results: Two hundred and eighty-one patients with TAWH were identified. One hundred and seventy-six (62.6%) patients underwent operative hernia repair, and 105 (37.4%) patients underwent nonoperative management. Of those undergoing surgical intervention, 157 (89.3%) were repaired during the index hospitalization, and 19 (10.7%) underwent delayed repair. Bowel injury was identified in 95 (33.8%) patients with the majority occurring with rectus and flank hernias (82.1%) as compared with lumbar hernias (15.8%). Overall hernia recurrence rate was 12.0% (n = 21). Nonoperative patients had a higher Injury Severity Score (24.4 vs. 19.4, p = 0.010), head Abbreviated Injury Scale score (1.1 vs. 0.6, p = 0.006), and mortality rate (11.4% vs. 4.0%, p = 0.031). Patients who underwent late repair had lower rates of primary fascial repair (46.4% vs. 77.1%, p = 0.012) and higher rates of mesh use (78.9% vs. 32.5%, p < 0.001). Recurrence rate was not statistically different between the late and early repair groups (15.8% vs. 11.5%, p = 0.869)., Conclusion: This report is the largest series and first multicenter study to investigate TAWHs. Bowel injury was identified in over 30% of TAWH cases indicating a significant need for immediate laparotomy. In other cases, operative management may be deferred in specific patients with other life-threatening injuries, or in stable patients with concern for bowel injury. Hernia recurrence was not different between the late and early repair groups., Level of Evidence: Therapeutic/care management, Level IV., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)