Surgical patients in Ghana, Benin and India will help design a new type of clinical trial that could test multiple treatments at once, rather than one at a time. Patients in low- and middle-income countries (LMICs) are far more likely to die or suffer complications after surgery than those in wealthy nations. Yet the standard approach to testing new interventions—running one trial for each drug or procedure—is slow, expensive, and poorly suited to resource-limited settings. Adaptive platform trials, which can add or drop treatments mid-study without restarting, have never been used for surgery in LMICs. This project tackles the preparatory work needed before launching such a trial. Researchers will run workshops with patients, clinicians and policymakers to define what “good recovery” means in these contexts. They will also rank the most promising, low-cost interventions—such as infection control bundles or early mobilisation—and test whether an adaptive design would work better than a conventional one by re-analysing data from a previous global surgery trial. If successful, the resulting platform trial could rapidly identify which simple, affordable interventions actually save lives after surgery in LMICs. The project also trains local researchers, building the expertise needed to sustain such trials long-term.
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> Background Surgical patients in low- and middle-income countries (LMICs) face significantly higher risks of post-operative complications and mortality compared to those in high-income settings. Adaptive platform trials offer an efficient methodology to evaluate multiple interventions concurrently, but no such trial has been conducted in LMICs. > Aims and objectives Before launching a full-scale Perioperative Multifactorial Adaptive Trial (PUMA), key uncertainties must be addressed: (1) Defining a context-appropriate measure of recovery after surgery (2) Identifying simple, high priority interventions for initial evalution (3) Determining the optimal trial design for LMIC patients and communities > Methods This project will focus on three preparatory workstreams with partners in Ghana, Benin and India (WS): (WS1): In nominal group consensus workshops involving LMIC patients, clinicians, and policymakers, we will agree a measure of recovery after surgery. (WS2): Co-develop a prioritised list of interventions for PUMA through a scoping review, discrete choice experiments, and a structured Delphi process. (WS3): Work with statisticians to perform Bayesian re-analysis of previous global surgery trial to evaluate whether an adaptive design would enhance efficiency, and conduct sample size simulations for both patient and cluster randomised interventions. > Impact The outputs will directly inform a future platform trial, ensuring that interventions tested are clinically relevant, resource-appropriate, and equitable. This project also serves as a training vehicle for both me and emerging LMIC research leaders, fostering capacity building and sustainable research networks. Together, these will underpin my application to a postdoctoral career advancement fellowship.
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