Table 3 Questions put forward for Phase II prioritisation

General EGS

Which pre- or post-operative interventions improve clinical outcomes in patients with frailty after emergency surgery?

How can training be improved to meet emergency general surgery demand, including open surgery?

What is the impact of emergency laparotomy on quality of life in frail patients?

What are the best predictors of adverse outcomes and mortality in older adults presenting with emergency general surgery pathology?

What are the absolute risks of anastomotic leak following emergency small bowel/large bowel anastomosis, and the relative importance of risk factors?

How can we optimise the rate of reversal of Hartmann’s when performed as an emergency and what are the predictive factors in those who are subsequently reversed?

Does a laparoscopic approach for adhesional small bowel obstruction reduce the risk of recurrence, and how do we identify those who would benefit most from laparoscopic approach?

What is the value of enhanced recovery after surgery (ERAS) programmes for EGS patients, compared to standard management?

How does small bites closure compare to traditional mass closure in the emergency setting (wound infection, fascial dehiscence and incisional hernia rates)?

Should patients have extended venous thromboembolism (VTE) prophylaxis after an emergency laparotomy with or without resection?

What is the optimal method of assessing fitness for surgery in the emergency setting?

How does negative pressure wound therapy affect clinical outcomes after emergency surgery?

Are outcomes after emergency surgery improved with the laparoscopic approach as compared to the open approach?

Is the use of mesh safe for the repair of a strangulated hernia where there has been small bowel contamination via enterotomy?

Which cohort of EGS patients derive the greatest benefit from post-operative chest physio?

What is the optimum timing of hernia repair after successful reduction in cases of acute incarceration?

Emergency UGI surgery

Should management of acute cholecystitis in the geriatric population differ from standard care?

Does a ‘hot gallbladder’ pathway reduce sepsis rates in addition to gallstone-related complications?

Should every centre that offers emergency general surgery offer a ‘hot gallbladder’ service? Which model is best and is pre-operative MRCP required?

Is therapeutic anticoagulation indicated in cases of portal vein thrombus secondary to acute severe pancreatitis?

Can mild acute pancreatitis be managed in an ambulatory setting and in which patients is it safe to do so?

Is cholecystostomy adequate in cases of empyema gall bladder in an older adult unfit patient or is interval cholecystectomy required?

Emergency colorectal surgery

Does a formal cancer resection improve disease-free and overall survival in perforated or obstructing emergency colorectal cancer resections?

How do stent, stoma or immediate resection for obstructing colorectal cancers compare?

Endoscopic obstructing colorectal tumour: what should we do and what is the best timing for surgical intervention?

What are oncologic results in colon cancer treated in an emergency situation?

Is endoscopic follow-up required in CT-confirmed acute diverticulitis?

Regarding the various treatment strategies in lower gastrointestinal bleeding (e.g. surgical, endoscopy, interventional radiology, medical systemic treatment), is single or combination treatments superior?

Could FIT testing be used to screen for possible colorectal malignancy in diverticulitis patients rather than routine post-admission endoscopy/CT Colonography?

Is there a CRP level (or other marker) which could identify cases of diverticulitis which can safely be managed conservatively, i.e. antibiotics versus no antibiotics?

What is the best operative strategy to achieve laparoscopic resection in obstructing left-sided colorectal cancers?

What is the incidence and indications/selection criteria for surgical intervention with sigmoid volvulus?

Non-technical

Which human/organisational factors cause inefficiency in a dedicated emergency theatre?

What influences decision-making for emergency surgery for the surgeon, patient and family?

Health service related

Are emergency surgical outcomes improved with peri-operative physician or geriatrician input?

Is there a need for an ‘Emergency Surgery’ sub-specialisation?

Is there a volume–outcome relationship for emergency surgery?

What effect does a fast-track service have on the overall EGS service for patients requiring urgent cholecystectomy, appendicectomy and hernia surgery?

How can the informed consent process be optimised for emergency general surgery patients?

Is there a benefit when a senior decision-maker sees the patient first?

Are there improved outcomes in patients who are treated on a triaged speciality take? (e.g. pancreatitis to UGI, colon cancer to colorectal)