FROG (Frequency Rates, mOrbidities and timinGs) of Surgical Interventions for UC: A Protocol for an International, Multi‐Centre, Retrospective Cohort Study on Frequency Rates, Morbidities and Timings of Surgical Interventions for Ulcerative Colitis

ABSTRACT Background The surgical journey of patients diagnosed with ulcerative colitis (UC) typically begins with an index colectomy, which may be followed by restorative procedures or further operations due to complications. Variation in surgical strategies exists, impacting patient outcomes. This study aims to comprehensively map the surgical trajectory of UC patients, providing insights into complications, morbidity and optimal operative strategies. Methods This is the protocol for a retrospective multi‐centre pan‐European cohort study. Data will be collected from 2010 to 2024, including all adult UC patients undergoing an index colectomy. Subsequent procedures, including ileo‐anal pouch formation, ileorectal anastomosis, Kock pouch and operations for complications will be analysed. Postoperative outcomes, morbidity (Clavien–Dindo III–V), and the frequency of subsequent surgeries will be documented. Data entry will occur via the REDCap platform, with appropriate data governance agreements in place, and the data will be analysed by a central team, with statistical support. Ethics and Peer Review The study has received full ethics approval in the United Kingdom (UK) (IRAS number 342922). It has been peer‐reviewed, through the European Crohn's and Colitis Organisation (ECCO) Clinical Research Committee (ClinCom) (2024) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) Research MDT (2025). Dissemination The study is being actively disseminated by ECCO and features on the ACPGBI/BRUK (Bowel Research UK) research application. Other explored avenues include professional networks, national representatives and social media channels to maximise recruitment. Conclusion This collaborative study establishes a pragmatic scalable framework for capturing real‐world UC surgical data across Europe, fostering meaningful collaboration and greater standardisation in reporting. By highlighting variation in practice and outcomes, it supports targeted quality improvement and strengthens the evidence base guiding surgical management. Future Perspectives By examining a 15‐year period, this work will deliver a uniquely representative snapshot of UC surgical practice across diverse centres and countries, enabling an overview of operative strategies and complication profiles, and identifying priorities for future prospective research. It also lays the groundwork to explore collaboration for an international prospectively maintained UC surgery registry.