Table 1

Summary of preoperative, intraoperative and postoperative audit standards

Audit standard	Guidelines	Reporting in GECKO
Preoperative
Interventional radiology service: There should be 24-hour access to interventional radiology to support the delivery of an emergency HPB service	AUGIS13	We will report presence of 24-hour access to interventional radiology (yes/no) on a hospital-level basis.
Risk Stratification: For patients with acute cholecystitis, surgeons need to risk stratify using the Tokyo Guidelines 18 (TG18)	SAGES6	We will determine use of risk stratification on an individual patient basis. This will be used for further analyses at the hospital, country, and World Bank Income Group level.
Timing of surgery: In patients presenting with acute cholecystitis, the optimal timing for cholecystectomy is within 48 hours.	WSES12	We will determine timing of surgery on an individual patient basis. This will be reported as within 48 hours, 48 hours to 10 days, and >10 days of admission.
Intraoperative
Critical safety view (CVS): The use of the CVS during laparoscopic cholecystectomy (achieving all three components) is the recommended approach to correctly identify relevant anatomy and minimise the risk of bile duct injuries.	WSES7 12	We will determine whether all components of the critical view of safety is achieved on an individual patient basis.
Intraoperative imaging: in patients with uncertainty of biliary anatomy or suspicion of bile duct injury, intraoperative imaging (eg, cholangiogram, laparoscopic ultrasound and incisionless cholangiography with fluorescence) may help delineate relevant anatomy and decrease the risk of bile duct injury.	WSES12 15 16	We will determine the use of intraoperative imaging on an individual patient basis. This will be used for further analyses at the hospital, country and World Bank Income Group level.
Bailout procedures: When CVS cannot be achieved during laparoscopic cholecystectomy, a bailout procedure (eg, subtotal cholecystectomy or total cholecystectomy by the fundus-first (top down) approach) should be considered.	WSES12	We will determine the rates of subtotal cholecystectomy when CVS was not achieved on an individual patient basis. This will be used for further analyses at the hospital, country, and World Bank Income Group level.
Antibiotic use: Antibiotics are not required in low-risk patients undergoing laparoscopic cholecystectomy but may reduce the incidence of wound infection in high-risk patients.	SAGES14	We will determine the rates of antibiotic use on an individual patient basis. This will be used for further analyses at the hospital, country, and World Bank Income Group level.
Use of drains: drains are not needed after elective laparoscopic cholecystectomy.	SAGES14	We will determine the rates abdominal drains during elective cholecystectomy. This will be used for further analyses at the hospital, country and World Bank Income Group level.
Bile duct injury (BDI): If major BDI occur, outcomes are improved by early recognition and immediate referral to experienced hepatobiliary specialists for further treatment before any repair is attempted by the primary surgeon, unless the primary surgeon has significant experience in biliary reconstruction. If considering all types of BDIs, rates are <0.4% and <0.8% for elective and emergency settings, respectively. It is recommend knowing Strasberg’s classification (ie, documenting the classification during each operation), which remains the most used classification for BDIs	WSES12, SAGES14	We will determine bile duct injury on an individual patient basis. This will be used for further analyses at the hospital, country and World Bank Income Group level. We will identify the overall reporting of the Strasberg classification as recorded in the patient’s notes/case report form.
Postoperative
30-day readmission: rate should be <10%.	AUGIS13	We will determine the rates of readmission on a hospital-level basis. This will be used for further analyses at the country and World Bank Income Group level.
Critical care: There should be access to critical care beds with on-site renal support.	AUGIS13	We will determine the access to critical care beds on a hospital-level basis. This will be used for further analyses at the country and World Bank Income Group level.

AUGIS, Association of Upper Gastrointestinal Surgeons; GECKO, Global Evaluation of Cholecystectomy Knowledge and Outcomes; SAGES, Society of American Gastrointestinal and Endoscopic Surgeons.