Background: Clinical practice guideline development continues to increase worldwide. AGREE-II is a well-recognized tool for the evaluation of the quality of guidelines. A surgical extension, AGREE-S, was developed in 2022. We aim to evaluate the difference in appraisal of surgical clinical practice guidelines using AGREE-S versus AGREE-II. Methods: A systematic review was conducted using Pubmed and the International Guidelines Library to ultimately identify twenty surgical, interventional and procedural-related guidelines. A minimum of four different appraisers used both AGREE-II and AGREE-S to evaluate all twenty guidelines. A univariate linear mixed-effects regression model was used to compare scoring between the domains in each tool (95% CI, p-value <0.05) and intraclass correlation coefficient (ICC) was used to determine reliability (p-value <0.05). Results: Four of the seven different domain comparisons conducted between the two instruments demonstrated a statistically significant mean difference with the largest seen in Clarity of Presentation in AGREE-II versus Development of Recommendations in AGREE-S. Overall quality for surgical guidelines was a median of 4.1 out of 7. Only two guidelines had a unanimous decision amongst all reviewers to recommend without modification. Both tools demonstrated good reliability with an average ICC of 0.81 (0.78,0.083; p-value <0.001). Conclusions: The AGREE-S extension helps provide a more rigorous and relevant evaluation of the guidelines developed for surgical and procedural applications compared to AGREE-II. Future research and application of AGREE-S will be critical in validating its effectiveness and promoting its adoption into surgical guideline development and appraisal.