Required data fields
| Patient ID | Local hospital field |
| Age | If >2 years = whole years, if <2 years = months |
| Gender | Male, female |
| ASA score | I, II, III, IV, V, not recorded |
| Immunosuppression | Diabetes: Diet controlled, Tablet controlled, Insulin controlled, No HIV: Yes—on antiretroviral therapy; Yes—not on antiretroviral therapy, No, Unknown Steroids: Yes, No Other immunosuppressive drugs (eg, azathioprine, methotrexate, biologic agents): Yes, No Chemotherapy (current chemotherapy or if the last cycle was within 12 weeks of operation): Yes, No Active malarial infection: Yes—confirmed by blood film or equivalent test, No |
| HIV: Yes—most recent preoperative CD4 count | |
| Smoking status | Current smoker (including those who stopped smoking within the last 6 weeks), Previous smoker, Never smoked, Unknown |
| Date and time of admission | DD/MM/YYYY HH:MM |
| Date and time operation started (knife to skin time) | DD/MM/YYYY HH:MM |
| Length of operation (knife to skin until point of completion) | Minutes |
| Urgency of operation | Emergency (any surgery on the same admission as diagnosis), Semielective, Elective (any planned admission for surgery) |
| Was a surgical safety checklist used (WHO or an equivalent)? | Yes, No—but available in this centre, No—not available in this centre |
| Initial operative approach | Open midline, Open non-midline, Laparoscopic, Laparoscopic converted to open, Robotic, Robotic converted to open |
| Primary operation performed | Pick from drop-down list; pick single main procedure performed |
| Appendicectomy—Appearance at surgery: simple (non-perforated), complex (perforated, free pus), normal | |
| Appendicectomy—Duration of symptoms (eg, abdominal pain) prior to surgery (days 0, 1, 2, 3, 4, 5, 6, 7+) | |
| Main surgical pathology/indication (the main cause leading to surgery) | Malignant (proven or suspected tumour/cancer), Benign |
| Intraoperative contamination | Clean contaminated: GI tract entered but no gross contamination Contaminated: GI tract entered with gross spillage or major break in sterile technique Dirty: There is already contamination prior to operation (eg, with faeces or bile) |
| Antibiotic use | |
| Used for treatment before surgery (eg, trial of antibiotics to treat diverticular abscess) | Yes (total days), No |
| Used for prophylaxis at the point of incision (ie, standard hospital prophylaxis) | Yes, No |
| Continued at the end of surgery (ie, extended prophylaxis after surgery) | Yes (total days), No |
| Was epidural analgesia inserted on the day of surgery? | Yes, No |
| Were NSAIDs used postoperatively during the first 5 days of after surgery? (including ibuprofen, naproxen, diclofenac, ketorolac and etoricoxib, excluding aspirin) | Yes, No |
| Was serum haemoglobin/haematocrit checked in the first 48 hours postoperatively? | Yes—serum haemoglobin, Yes—capillary PCV, No—but tests available in this centre, No—tests not available in this centre |
| Was serum creatinine checked in the first 48 hours postoperatively? | Yes, No—but available in this centre, No—not available in this centre |
| Length of postoperative stay | Days |
| Surgical site infection | |
| Prior to discharge | Yes, No |
| At 30 days after surgery | Yes, No, Not assessed after discharge |
| If yes: Was a wound swab sent for microbiological culture: Yes, No—but available in this centre, No—not available in this centre | |
| If yes: How was this treated: operative drainage, wound opened outside of operating theatre, antibiotics (tick all that apply) | |
| What bacteria, if any, were identified? | None, Staphylococcus aureus, Coliform, Anaerobe, Other (five tick boxes) |
| If yes: Sensitivity: sensitive to antibiotic prophylaxis given; resistant to antibiotic prophylaxis given; sensitivities not tested—but available in this centre; sensitivities not tested—not available in this centre | |
| 30-day unexpected reintervention. Record the most serious reintervention | Yes—surgical, Yes—endoscopic, Yes—interventional radiology, No |
| 30-day mortality | Dead, Alive, Unknown. If died: postoperative day of death |
| 30-day intra-abdominal/pelvic abscess (CT, ultrasound or clinical (including reoperation) evidence of intra-abdominal or pelvic abscess) | Yes, No |
| Other hospital-acquired infection (treated with or without antibiotics) | Yes—urinary tract infection, Yes—pneumonia, Yes—central venous line infection, Yes—peripheral line infection, Yes—other, No |
| How was 30-day follow-up status achieved? (all applicable) | Still an inpatient, Clinic review, Telephone review, Community/home review, Discharged before 30 days and not contacted again |
ASA, American Society of Anaesthesiologists; GI, gastrointestinal; NSAID, non-steroidal anti-inflammatory drug; PCV, packed cell volume.