A global network of 230 hospitals across 43 low- and middle-income countries is running clinical trials to reduce surgical wound infections, starting with abdominal surgery. Surgical site infections are a major cause of death and disability in poorer countries, yet most surgical research has focused on high-income settings. The Global Surgery Research Unit, led by the University of Birmingham, builds on a pre-existing collaboration that has already collected data from 27,000 patients and produced a paper ranking in the top 1% of research impact. The unit will run randomised trials through five regional hubs—in West Africa, Southern Africa, Central and East Africa, Central America, and South Asia—each supporting up to eight spoke hospitals. If successful, the trials will produce evidence that can be turned into low-cost, practical guidelines for operating rooms in resource-limited settings. The unit also trains local surgeon-investigators to design and lead their own studies, creating a self-sustaining research infrastructure. The ultimate goal is to standardise intra-operative care in the same way the WHO Surgical Safety Checklist standardised pre-operative practice, but tailored to the realities of district hospitals in low-income countries.
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BACKGROUND Existing Network (Fig 1): GlobalSurg (www.globalsurg.org, Twitter: @globalsurg) is a collaboration of frontline surgeons, spanning 230 hospitals from 43 LMIC countries, working to address the unmet need for research in global surgery. It was founded in 2013, joining surgeons from LMICs with researchers from the Universities of Birmingham (UoB), Edinburgh (UoE) and Warwick (UoW). Together, we are applying to form a Global Surgery Research Unit. GlobalSurg has established a secure, worldwide data collection platform and completed two prospective cohort studies including 27,000 patients. Our first paper on emergency abdominal surgery [1] is ranked in the top 1% of Altmetric research outputs. In 2016, GlobalSurg prioritised a research question (surgical site infection) and finalised a trial protocol (RCT-1) to be delivered through five GlobalSurg research ‘Hubs’ reaching into 40 GlobalSurg ‘Spoke’ research hospitals. Institutional Strategies: The strategies of GlobalSurg and the UK consortium are aligned with those of the United Nation’s Sustainable Development Goals and the Government’s UK Aid manifesto, detailed in our ODA compliance statement. UoB, UoE and UoW have high-level strategic objectives focused around partnerships and international research impact, bringing complementary expertise, detailed in Team expertise and Research capacity. VISION The Global Surgery Research Unit will create a sustainable platform of frontline clinicians, prioritising and delivering research that will challenge and change surgical care relevant to patients in low and middle income countries (LMICs). The Unit will build on the success of the pre-operative WHO Surgical Safety Checklist [2], by evaluating and standardising intra-operative practice. Our pre-application phase has identified prevention of abdominal wound infection as our first research priority. Results from clinical research will be transformed into guidelines and cost-effective policy through our Global Surgery Policy Consortium (GSPC, see Collaborations), which will work across our 230-centre network to deliver sustainable global change. CAPACITY BUILDING (Fig 2) Five core-funded regional Hubs (West Africa, Southern Africa, Central and East Africa, Central America, South Asia) will support 40 surgeon-investigator “Spokes”. These represent central and district hospitals in LMICs, and will recruit into randomised trials. Hubs have local senior surgeon-leaders, who have secured high-level administrative support at each of their institutions (Supporting Letters). We have finalised the protocol for RCT-1 (see Additional Information), which will be piloted in the Hubs (Yr1) and then rolled out into a full trial to develop the Spoke infrastructure. This will deliver evidence to change practice within the funding envelope, and enable further interventional trials across the platform. With the first three Hubs, we will create a toolkit to streamline site set up. Our surgeon-investigators are already establishing ethical approval processes, research contracts, and Good Clinical Practice certification. Bespoke training packages will move Hub staff towards autonomy within the 4yr funding envelope. SCIENTIFIC STRATEGY Strategy is centred around Prioritisation Cycles (PCs, Fig 3). These will be initiated through GlobalSurg and led by LMIC Hubs at an annual workshop and delivered through 4 stages: 1. Workshops, 1-week long, including bespoke workshop training 2. Information Gathering, including feasibility studies 3. Evidence Generation, through trials, cohort studies, service delivery evaluation 4. Sustainability and Output, generating competitive external funding applications, and influencing global clinical policy 1. WORKSHOPS Annual Workshops will be hosted by Hubs, and will use two functions to drive the PCs. Firstly, to select new research priorities (as shortlisted by Hubs/Spokes). Secondly, to share experience in set up and training, Spoke develo
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