Introduction The Dr Foster Global Comparators Network (GC) aims to improve quality in healthcare by promoting inter-hospital collaboration through sharing of outcome data and benchmarking standards.

This study aims to utilise the GC database to establish whether geographical differences in outcomes exist following high-risk emergency general surgery (EGS) admissions, whilst determining if structural differences between healthcare systems can be linked to high-quality care.

Method Discharge data for a cohort of EGS patients were collated using a pre-determined protocol. Hierarchical logistic regression analysis was performed to examine geographical and structural differences between GC hospitals.

Results 69,490 patients, admitted to 23 centres across Australia, England and the USA with high-risk EGS diagnoses from 2007–2012 were identified. Outcomes including: seven/thirty-day mortality, readmission and length of stay were all superior in the USA.

19,082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at seven-days in this subgroup. Thirty-day mortality (OR = 1.47) readmission (OR = 1.42) and length of stay (OR = 1.98) were all worse in the UK.

Across this cohort, patient factors, (age, pathology and co-morbidity) were significantly associated with worse outcome as were structural factors including: low ITU bed ratios, high unit volume and inter-hospital transfers. Having dedicated EGS teams cleared of elective commitments with formalised handover of patients was associated with shorter length of stay.

Conclusion Post-operative outcomes were similar at seven but not at thirty-days. This may be attributable to better infrastructure and resource allocation towards EGS in the US. The costs associated with this healthcare gain were not measured.