Purpose: Cholecystectomy is one of the most common operations globally, with laparoscopic surgery the “gold standard” approach. However, there is a paucity of global evidence for the variations of safe provision of cholecystectomy, including low- and middle-income countries. This international collaborative study by the GlobalSurg Collaborative will allow contemporaneous data collection on the quality of cholecystectomies using measures covering infrastructure, care processes and outcomes. 
Methodology: GECKO is a prospective, international, multicentre, observational cohort study delivered by the GlobalSurg Collaborative. Consecutive patients undergoing cholecystectomy between 31st July 2023 to 19th November 2023 were recruited, with follow-up at 30-days and one-year postoperatively. The study was undertaken at any hospital providing emergency or elective surgical services for biliary disease. The primary endpoint of this study is compliance with pre-, intra-, and post-operative audit standards. Secondary outcomes include rates of 30-day complications, achievement of critical view of safety and rates of gallbladder cancer.

 Results: The study has recruited 54,506 patients from 1260 centres across 110 countries (3570 patients in Australia and New Zealand). Australia recruited 73 centres across all states and territories, including metropolitan, regional and remote hospitals. Centre-level data have also been collected from >1400 centres globally. Results from this international cohort study will be presented during the meeting. 

 Conclusion: This study collected routinely available data on a global scale and will inform future clinical practice.