title: Determining universal processes related to best outcome in emergency abdominal surgery: a multicentre, international, prospective cohort study.
abstract: BACKGROUND
  Emergency abdominal surgery outcomes represent an internationally important marker of healthcare quality and capacity. In this study, a novel approach to investigating global surgical outcomes is proposed, involving collaborative methodology using 'snapshot' clinical data collection over a 2-week period. The primary aim is to identify internationally relevant, modifiable surgical practices (in terms of modifiable process, equipment and clinical management) associated with best care for emergency abdominal surgery.
  
  
  METHODS
  This is a multicentre, international, prospective cohort study. Any hospital in the world performing acute surgery can participate, and any patient undergoing emergency intraperitoneal surgery is eligible to enter the study. Centres will collect observational data on patients for a 14-day period during a 5-month window and required data points will be limited to ensure practicality for collaborators collecting data. The primary outcome measure is the 24 h perioperative mortality, with 30-day perioperative mortality as a secondary outcome measure. During registration, participants will undertake a survey of available resources and capacity based on the WHO Tool for Situational Analysis.
  
  
  BACKGROUND
  The study will not affect clinical care and has therefore been classified as an audit by the South East Scotland Research Ethics Service in Edinburgh, Scotland. Baseline outcome measurement in relation to emergency abdominal surgery has not yet been undertaken at an international level and will provide a useful indicator of surgical capacity and the modifiable factors that influence this. This novel methodological approach will facilitate delivery of a multicentre study at a global level, in addition to building international audit and research capacity.
  
  
  BACKGROUND
  The study has been registered with ClinicalTrials.gov (Identifier: NCT02179112).
authors.affiliation: West Midlands Deanery General Surgery Rotation.
authors.forename: Aneel
authors.initials: A
authors.lastname: Bhangu
authors.affiliation: University College London, London, UK.
authors.forename: J Edward
authors.initials: JE
authors.lastname: Fitzgerald
authors.affiliation: Department of Surgery, University of Edinburgh, Edinburgh, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Fergusson
authors.affiliation: Imperial College London Medical School, London, UK.
authors.forename: Chetan
authors.initials: C
authors.lastname: Khatri
authors.affiliation: Paediatric Surgery and Global Paediatrics, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
authors.forename: Hampus
authors.identifier: http://orcid.org/0000-0003-3745-7402
authors.initials: H
authors.lastname: Holmer
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
authors.affiliation: Department of Surgery, University of Edinburgh, Edinburgh, UK.
authors.forename: Ewen M
authors.initials: EM
authors.lastname: Harrison
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015331:Cohort Studies; D003625:Data Collection / Q000379:methods; D004630:Emergencies; D006801:Humans; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D013514:Surgical Procedures, Operative
keywords: EPIDEMIOLOGY