Provenance and peer review: Not commissioned; internally peer reviewed.
Surgery has an undeservedly low profile in global health priorities.1 It was not mentioned in the Millennium Development Goals despite an estimated 11–15% of the global burden of disease amenable to surgical treatment.2 Currently, TAK-875 structure an estimated 234 million major surgeries are performed worldwide per year, but less than 4% of these reach the populations of the poorest one-third of the world’s countries,3 indicating that there is a considerable unmet surgical

need, which has been shown by population-based studies.4 The situation is aggravated by an acute shortage of patient-level data on surgical outcomes globally5—data

from high-income countries (HICs) may lack relevance and comparability in low-income and middle-income countries (LMICs)—but previously published work from the UK indicates that postoperative mortality affects up to 15% of patients and morbidity up to 30%.6 7 There may be a double burden of low access to surgical care and high risk of adverse outcomes in large parts of the world and there is growing recognition of the need to address this issue, as manifested by the recently launched Lancet Commission on Global Surgery,8 the upcoming third edition of the Disease Control Priorities Project with a full volume on Surgery, and the recent decision by the WHO Executive Board to include a proposed resolution on access to safe surgery and anaesthesia on the agenda of the 2015 World Health Assembly. Emergency abdominal surgery, including laparotomy, appendectomy and hernia repair is performed in acute hospitals across the world and is likely to be subject to performance variation.9 Emergency laparotomy is a standard of acute abdominal surgery (including for traumatic injuries, a leading cause of death in young people

around the world10), and is the most invasive procedure with the highest side effect profile.7 Aims In order to address the lack of surgical outcomes data, we will conduct a global audit of emergency abdominal GSK-3 surgery outcomes, utilising a novel approach to a global surgical outcomes project, that involves collaborative methodology, including institutions in HIC and LMIC settings, and using ‘snapshot’ clinical data collection.11 12 This is in keeping with a proposed framework by an international expert group.13 The primary aim of this study is to identify modifiable surgical practices (in terms of modifiable process, equipment and clinical management) associated with best care. The secondary aims are to describe the epidemiology of indication for emergency abdominal surgery and determine baseline experience and capacity for local audit in surgical settings.