Authors: Dr Elizabeth Lun, Dr Mathew McGuinness, Associate Professor Richard McGee, Stephanie Baldwin, Dr Deborah Wright, Professor Amanda Dawson, and Dr Theophilus Anyomih

The Global Surgery Unit is pleased to announce a new Trainee-led collaborative cohort research opportunity called the Appendicitis Global Outcomes Study (AlliGatOr). This study is delivered by the management team from the National Institute for Research Health (NIHR) unit on Global Surgery. This team has successfully delivered the GlobalSurg, COVIDSurg, Hernias, Pathway and Planetary Outcomes (HIPPO) and Global Evaluation of Cholecystectomy Knowledge and Outcomes (GECKO) studies.

The lead investigator for AlliGatOr is UK surgical Trainee Dr Theophilus Anyomih of the NIHR unit on Global Surgery.

AlliGatOr is an international prospective multicentre cohort study, which aims to identify areas for whole systems strengthening in emergency care using pre-defined key performance measures. Acute appendicitis is one of the most common surgical emergencies worldwide. Presentation of appendicitis and its management can serve as a benchmark to evaluate the efficiency and effectiveness of emergency health systems. ^1,2,3

Study participation details
Key study features:
•    Prospective, observational cohort study, with no changes to patient management.
•    All hospitals globally performing appendicectomy can participate.
•    Data collection will be eight two-week periods between February and May 2025.
•    All collaborators will be included as PubMed citable co-authors on resulting publications.

AlliGatOr will include consecutive patients undergoing appendicectomy for suspected appendicitis. A measurement set comprising key outcome measures has been predefined to comprehensively evaluate global emergency system performance. Hospital teams of up to three collaborators will collect data on consecutive patients of any age undergoing appendicectomy in predefined 14-day blocks. Patients will be followed up at 30 days to collect outcome data. Multiple teams may participate in data collection in the same hospital but in different 14 day blocks. There will be no changes made to routine patient care pathways/management or follow-up. There is also a mandatory site survey for all participating hospitals together with a nested sub-study on sustainability and waste management.

AlliGatOr will generate granular data on the global variability in appendicectomy management and outcomes, offering insights into access to emergency care, imaging, and minimally invasive surgery. The findings will guide recommendations for both high income and low- and middle-income countries, informing government policy and improving patient outcomes.
Currently we are recruiting hospital leads and co-leads from around Australia and Aotearoa New Zealand with data collection from February until May 2025. There are still plenty of opportunities to participate.

In 2020 an Australia New Zealand Journal of Surgery article showed student and Trainee collaborative networks provided excellent opportunities to improve research skills and contribute meaningfully to surgical academia. The importance of collaborative research participation is acknowledged in requirements for SET applications and GSET research requirements due to the real-world practice in teamwork, leadership, professionalism and communication⁴. The PubMed citable authorship model recognises these predefined contributory roles.

In 2023 the British Journal of Surgery further emphasised the major impact of Trainee collaboratives and their important role in a surgical culture that places emphasis on conducting high quality research with a resultant growth in global surgical research output⁵.

In Australia, national lead Professor Amanda Dawson and co-leads Associate Professor Richard McGee and Dr Elizabeth Lun obtained national ethics approval with a waiver of patient consent via a greater than low risk pathway together with state-based approval pathways in Western Australia, Victoria, South Australia and Queensland. This study is supported by Surgical Trainee Organisation for Research – Central Coast (STORCC).

In Aotearoa New Zealand, co-national leads Dr Deborah Wright, Stephanie Baldwin and Dr Matthew McGuinness have submitted Health and Disability Ethics Committee (HDEC) approval, which is awaiting review. This study is supported by Surgical Trials Research, Audit and Trials Aotearoa (STRATA).

Registration and further information  

Interested parties can register as hospital leads or co-leads

You can find more information here.

If you have any questions, please email Professor Amanda Dawson.

 
References
¹ Kamarajah S, El Boghdady M, Anyomih T, Wohlgemut J, Bhangu A. State of the Art Review: Evidence based management of acute appendicitis. Impact Surgery. 2024 Apr 12;1(2):35–40.
² Kulasekere DA, Royan R, Shan Y, Reyes AM, Thomas AC, Lundberg AL, et al. Appendicitis Hospitalization Care Costs Among Patients With Delayed Diagnosis of Appendicitis. JAMA Netw Open. 2024 Apr 1;7(4):e246721
³ Han H, Letourneau ID, Abate YH, Abdelmasseh M, Abu-Gharbieh E, Adane TD, et al. Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021. The Lancet Gastroenterology & Hepatology. 2024 Sep 1;9(9):825–58
⁴ Hunter SPARTAN Collaborative, QUEST Collaborative, STORC Collaborative, et al. Trainee-and student-led research networks: promoting research skills and competency through collaboration. ANZ J Surg 2020; 90: 2177-2179.
⁵ Hutchinson PJ, Pinkney T, Mohan M, Cromwell D, van der Meulen J, Coomer M, Tomlinson R, King S, Akkulak M, Hinchliffe R, Beard DJ, Morton D, Orr L; members of the Royal College of Surgeons of England research initiatives. From opera buffa to opera seria: anniversaries of Royal College of Surgeons of England research initiatives. Br J Surg. 2024 Jan 3;111(1)