The document outlines a multi-centre, student-led study called 'discover' focusing on surgical complications in obese patients, coordinated by the student audit and research in surgery (starsurg) group. The study aims to assess compliance with NICE guidelines for identifying obese patients and to determine obesity's role as a risk factor for post-operative complications. Data will be collected by mini-teams across UK and Irish hospitals, with a primary outcome of major complication rates within 30 days post-surgery.

1. Student Audit and Research in Surgery
Supported by:
DISCOVER: Defining Surgical Complications in the Overweight
A multi-centre, student-led study of guidelines on obesity and post-operative complications.
STARSurg: Student Audit and Research in Surgery (STARSurg) is a national student-led
collaborative facilitating multi-centre audit and service evaluation
projects. STARSurg is co-ordinated by a steering group of medical
students and surgical trainees. It is represented locally by a network of 45
student leads covering all medical schools in the UK and the Republic of
Ireland.
Study participants: Any UK or Irish hospital offering elective and/or emergency surgery may
register DISCOVER. Mini-teams (two students and one doctor) will collect
data under the overall supervision of a consultant surgeon.
Study period: Each mini-team will collect data over a 14-day, consecutive period. Up to
three mini-teams may participate at each site collecting data over
successive periods. It is recommended that data collection takes place
during one of the following set periods:
§ Period 1: 0800 Wed 1st Oct to 0759 Wed 15th Oct.
§ Period 2: 0800 Wed 15th Oct to 0759 Wed 29th Oct.
§ Period 3: 0800 Wed 29th Oct to 0759 Wed 12th Nov.
Study registration: DISCOVER may be registered as clinical audit and/or service evaluation.
Study aims: (i) To establish compliance with NICE guidelines requiring early
identification of obese patients.
(ii) To determine the role of obesity as a risk factor for major post-operative
complications in current UK and Irish practice.
Audit gold standard: All patients should have BMI calculated on admission to hospital.
NICE CG 32, 1.2.2 All hospital inpatients on admission should be
screened for malnutrition.
NICE CG 32, 1.2.6 Screening should assess body mass index (BMI).
Inclusion criteria: All consecutive adult (age ≥18 years) patients with an overnight stay in
hospital, undergoing gastrointestinal surgery or hepatobiliary surgery
should be included. Include both emergency and elective patients and
both open and laparoscopic surgery.
Exclusion criteria: Minor anorectal surgery, transplant surgery, urological/ gynaecological/
vascular/ trauma indications for surgery.
Risk adjustment: Without adjusting for pre-operative risk, it is likely that any findings would
be biased. The following indices will be used to risk adjust outcomes:
§ ASA score.
§ Revised Cardiac Risk Index.
§ Malnutrition Universal Screening Tool (MUST) score.
§ Index of Multiple Deprivation.

2. Student Audit and Research in Surgery
Supported by:
Primary outcome: 30-day major complication rate (Clavien-Dindo grade III-V complications)
in the obese versus patients with normal weight.
Secondary outcomes: Procedure-specific complications, unplanned admission to critical care
unit, re-operation and re-admission.
Follow-up: The primary and secondary outcome measures will be recorded if they
occurred at any point from post-operative Day 1 (day of surgery) to Day
30. To ensure follow-up captures complications diagnosed at other
hospitals and in the community, mini-teams should consider calling
patients or general practitioners at 30-days. Telephone scripts will be
provided.
Data collection: Data will be collected and stored online through a secure, approved
University of Edinburgh server running the Research Electronic Data
Capture (REDCap) web application. REDCap is widely used
internationally by academic organisations to store research databases.
Data analysis: Data shall be analysed by the steering group. Data will not be analysed at
a surgeon level or centre level.
Authorship: All mini-team collaborators will be eligible for PubMed-citable authorship.
Each mini-team collaborator should participate in registering the audit,
identifying patients, collecting data and completing follow-up.
Funding: STARSurg is supported by INSPIRE.
INSPIRE is coordinated by the Academy of Medical Sciences and
supported by the Wellcome Trust. INSPIRE activities are designed and
delivered locally by individual medical schools.
Further information: For matters relating to mini-team setup and audit registration, please
contact your local lead (details at www.starsurg.org). For general enquiries
concerning the protocol, please contact the steering committee by email
(starsurguk@gmail.com) or on Twitter (@STARSurgUK).
Project timeline:
Sept 16 § National STARSurg meeting at RCSEng, London.
§ Full protocol published.
Aug 18 – Sept 26 § Local leads co-ordinate formation of mini-teams.
§ Audit is registered at each participating centre.
Oct 1 – Nov 12 Data collection periods (30-day follow-up ends Dec 12).
Dec 5 Preliminary results presented at National Research Collaborative Meeting
in Cardiff.