A global prospective cohort study on outcomes of appendicectomy for appendicitis - AlliGatOr

This prospective, multicenter, global cohort study will enroll patients within the study window from February 3, 2025, to May 25, 2025. Any hospital worldwide that performs appendicectomies will be eligible to participate, collecting data over a 14-day period for consecutive patients undergoing appendicectomy for suspected or confirmed acute appendicitis. Primary outcomes will be assessed at 30 days following surgery. No changes will be made to routine patient care pathways, clinical management, or follow-up, as this is an observational study.

The primary aim of this study is to identify opportunities for strengthening emergency surgery systems using appendicitis as a tracer condition, guided by a predefined set of key performance indicators.
The secondary aims are to evaluate variations in the presentation, diagnosis, management, access to minimally invasive surgery, and clinical outcomes among patients undergoing surgery for suspected acute appendicitis. These variations will be assessed across groups stratified by human development index, hospital funding model, urban versus rural setting, and facility level.

The study will be conducted through the NIHR GlobalSurg Collaborative Network, which has successfully delivered several international, multicenter, prospective cohort studies, including the GlobalSurg series, the COVIDSurg studies, and the HIPPO study (7–9). GlobalSurg 1 (2014) revealed substantial variation in outcomes following emergency abdominal surgery across different countries, while the COVIDSurg studies identified elective care as a global priority in the immediate future. The HIPPO study highlighted significant disparities in access and quality, and proposed targets for strengthening elective surgical systems. The AlliGatOr study has been designed to identify global gaps in emergency surgical care and to provide recommendations for improving emergency care pathways.