The Perioperative Quality Improvement Programme (PQIP patient study): protocol for a UK multicentre, prospective cohort study to measure quality of care and outcomes after major surgery
Authors: Moonesinghe S. Ramani , McGuckin Dermot , Martin Peter , Bedford James , Wagstaff Duncan , Gilhooly David , Santos Cristel , Wilson Jonathan , Dorey Jenny , Leeman Irene , Smith Helena , Vindrola-Padros Cecilia , Edwards Kylie , Singleton Georgina , Swart Michael , Baumber Rachel , Sahni Arun , Warnakulasuriya Samantha , Vohra Ravi , Ellicott Helen , Bougeard Anne-Marie , Chazapis Maria , Ignacka Aleksandra , Cripps Martin , Brent Alexandra , Drake Sharon , Goodwin James , Martinez Dorian , Williams Karen , Singh Pritam , Bedford Matthew , Vallance Abigail E. , Samuel Katie , Lourtie Jose , Olive Dominic , Taylor Christine , Tucker Olga , Aresu Giuseppe , Swift Andrew , Fulop Naomi , Grocott Mike ,   for the PQIP Project team and Clinical Reference Group, Moonesinghe Ramani , Aresu Giuseppe , Baumber Rachel , Bedford James , Bedford Matthew , Brent Alexandra , Chazapis Maria , Comish Jake , Cripps Martin , Dorey Jenny , Drake Sharon , Fulop Naomi , Gilhooly David , Goodwin James , Grocott Mike , Leeman Irene , Martin Peter , McCann Claire , McGuckin Dermot , Nasser Leila , Sahni Arun , Singh Pritam , Smith Helena , Snowden Chris , Stones John , Swart Mike , Tucker Olga , Vallance Abigail , Vindrola Cecilia , Vohra Ravi , Wagstaff Duncan , Wiliams Karen , Wilson Jonathan , Abercrombie John , Anwar Suhail , Bachelor Anna , Brett Stephen , Clark Tom , Cooper Graham , Crossley Anna , Dhesi Jugdeep , Digner Marie , Evans Elspeth , Hamilton Mark , Hill Robert , Huish Zoe , Mahajan Ravi , Murray Dave , Mythen Monty , McGhie Jonathan , McGrath John , Shinde Samantha , Speakman Mark , Swift Andrew , Vaux Emma 
Published: August 2022

Abstract
Introduction
Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery. Further, there is variation between national audit programmes, in the emphasis placed on quality assurance versus quality improvement, and therefore the principles of measurement and reporting which are used to design such programmes.

Methods and analysis
The PQIP patient study is a multi-centre prospective cohort study which recruits patients undergoing major surgery. Patient provide informed consent and contribute baseline and outcome data from their perspective using a suite of patient-reported outcome tools. Research and clinical staff complete data on patient risk factors and outcomes in-hospital, including two measures of complications. Longer-term outcome data are collected through patient feedback and linkage to national administrative datasets (mortality and readmissions). As well as providing a uniquely granular dataset for research, PQIP provides feedback to participating sites on their compliance with evidence-based processes and their patients’ outcomes, with the aim of supporting local quality improvement.

Ethics and dissemination
Ethical approval has been granted by the Health Research Authority in the UK. Dissemination of interim findings (non-inferential) will form a part of the improvement methodology and will be provided to participating centres at regular intervals, including near-real time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a comprehensive multi-modal communications strategy including to patients, policy makers and academic audiences as well as clinicians.