A global network of 70 hospitals across Africa, Asia, and the Americas is now running large-scale surgical trials to cut deaths and infections after operations. The problem is stark: five billion people lack access to safe, affordable surgery when they need it. Most existing surgical evidence comes from high-income countries, leaving surgeons in low- and middle-income countries (LMICs) to make decisions without data relevant to their patients. This unit has already completed trials involving 5,800 patients on wound infection prevention and is recruiting 11,000 more, plus observational studies covering 150,000 patients. If this succeeds, the research will produce practice-changing evidence on how to reduce postoperative mortality and surgical infection using technologies and systems that work in resource-limited settings. The unit is also building three training centres in LMICs to deliver postgraduate degrees and data management skills, transferring research leadership to local hubs. Community engagement committees will ensure findings reach patients and shape national guidelines. The goal is not just better surgery today, but a permanent, locally-run research infrastructure that can keep improving care for decades.
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Background: The NIHR Global Health Research Unit on Global Surgery (GSU) initially funded in 2017, established 7 surgical research Hubs (Benin, Rwanda, Ghana, India, Nigeria, Mexico, South Africa), coordinating research through more than 70 ‘Spoke’ hospitals across 3 continents, prioritised through LMIC led Delphi processes (2016-20). Research completed: A global randomised trial (RCTs) in wound infection prevention (5800 patients), second recruiting (11,000 patients), 4 prospective cohort studies (150,000 patients), 3 modelling studies, 7 pump-priming studies, 4 qualitative studies, 3 CEI projects and 2 guidelines, publishing 28 peer reviewed papers from this work. Proposal: In this funding envelope we will seek excellence through a new body of prioritised primary research, equitable partnerships through transfer of research leadership to the Hubs, sustainability through new Hub-based training centres. We will achieve this across 4 domains: Domain 1: Research • Interventional: Practice-changing evidence to rapidly evaluate healthcare technologies to improve patient outcomes; with focus on postoperative mortality and surgical infection. We will complete 2 new global RCTs, selected from 4 pilot RCTs (completed by 2022). • Observational: Themed around transforming systems of care, 4 projects will aim to strengthen whole health-system resilience for the surgical patient by: (i) Improving access to emergency surgery by applying health economic models (ii) Using data to support decision making in the post-pandemic recovery period (iii) Developing research questions for a new integrated rural surgery network (iv) Hub-led cohort studies targeted towards local priorities Domain 2: Education and Training Establish sustainable research capacity through new Hub-led and delivered training and education programmes. These will be delivered by bespoke Training Centres, responding to LMIC training needs, facilitating South-South collaboration and be accessible to other global health researchers. 3 bespoke Training Centres are proposed: • Surgical Research Skills: Providing postgraduate training programmes (23 MSc & PhDs). • Data Training: Embedded digital technology, data management, and analysis capability. • Management Training: To provide holistic research management support through the entire research programme lifecycle Domain 3: Community Engagement and Involvement (CEI) To date, we have established pathways into local communities by co-producing specific research projects with patient partners. Over the next 5 years, we will establish flexible, context-specific, and sustainable local CEI Steering Committees, coordinated through each Hub. CEI will be integrated into research prioritisation, research design and delivery, and act as a pathway to disseminate research to stakeholders. Domain 4: Impact We are seeking to deliver practice change to benefit patients across continents, through high-quality research. This will be achieved through three key mechanisms, reaching from the individual patient through to international policy teams: • Health service delivery through patient groups and clinical workers • Informing national guidelines reaching national surgical societies, health service providers • Multi-stakeholder dissemination of our outputs globally, with integrated impact assessment. Our impact will be evaluated and adapted during the programme, to begin sustainable transfer of ownership to the Hubs.
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