Latest Publication Asks Surgeons to Look Beyond the Operating Theatre to Save Lives Globally

Experts from the NIHR Global Health Research Unit on Global Surgery (GSU) propose three priority areas for surgery in publication for The Lancet

The Lancet Commission on Global Surgery, originally published in 2015 focused on lessening the healthcare based disparities faced by populations around the globe through the provision of high-quality surgical and anaesthesia care with financial protection when needed. The publication’s purpose was to achieve this vision through highlighting the importance of embedding of surgery within the global health agenda, galvanising political change, and defining scalable solutions for provision of quality surgical and anaesthesia care for all.

The publication in The Lancet from the GSU Collaborative have identified three key areas that have the most potential to reduce major causes of death and improve surgical access of care to all:

  1. Access, equity, and public health must be recognised as crucial issues for surgery – surgery has a key role in addressing global health challenges such as trauma, congenital anomalies, safe childbirth, and non-communicable diseases
  2. Inclusion and diversity must improve in both surgical research and the profession – advancing inclusion and diversity will ensure a research agenda that delivers a pragmatic and appropriate research reflecting the needs of all
  3. Climate change is the greatest global health threat facing the world – moving towards net-zero operating practices would reduce carbon emissions and enable surgeons/ policy makers to reassess the role of surgery within healthcare

The publication argues that despite the problems of large waiting lists and economic squeezes on health systems, focusing on these three key areas will ensure that surgical care can become a fundamental element of universal healthcare provision for all that will ultimately deliver major improvements in population health across the globe.

You can read more on the recently published article Surgical research – comic opera no more by clicking here.

You can also read further information on the publication in the University of Birmingham press release by clicking here.

Education and Training Webinar: EAGLE safe-anastomosis study

New webinar will look at the results from the recently completed EAGLE study

When is it?: Monday the 5th of June 2023 – 11:00 & 18:00 (GMT) – A 1hr webinar repeated twice during the day.

Who should attend?: Surgeons, surgical researchers, surgical nurses, scrub techs, ODPs and allied healthcare professionals

Hosted by: NIHR Global Health Research Unit        Hashtag:  #eagle2023

Anastomotic leak is a severe, potentially life-threatening complication following right colectomy. Internationally, anastomotic leak occurs after 8% of right colectomies. Prospective cohort data demonstrate that patient selection, intraoperative factors, and technical variation are risk factors for anastomotic leak. EAGLE was an international quality improvement programme to share best practice and harmonise procedures for surgeons and the theatre teams so that they might perform the best possible anastomosis for each particular patient. The study was carried out by 350+ hospitals across more than 60 countries.

This online webinar chaired by Prof. Dion Morton will provide all those working in surgical practice and research with an overview of the ground breaking global study EAGLE which is due to be published soon.

The main session will include three key presentations on (1) background and impact of anastomotic leak, (2) the design of the EAGLE study and (3) the headline results of the EAGLE study.

The format of the event includes a panel presentation of global experts discussing how the research was conducted, what the results showed, and the potential impact on surgical practice. There will be breakout sessions looking specifically at 2 key perspectives on the research (1) research methodology and results and (2) process evaluation. The webinar will conclude with a round table discussion of global experts discussing how these results can be implemented across the globe.

Register now to attend this ground breaking event

Register for the 11:00AM (UK BST) session using this form.

Or the 6:00PM (UK BST) session using this form.

You can also view Professor Dion Morton deliver a short promotional overview of the upcoming webinar by clicking here.

For instructions on how to use the Zoom meeting portal, desktop/ PC users click here for more information and iPhone/ Android users click here for further info.

NIHR Global Health Research Unit on Global Surgery (GSU) Attends 76th World Health Assembly in Geneva

Attendance at The Global Surgery Foundation (GSF) event enabled the GSU to identify pathways for Unit research to impact on global health policy

The event that took place in Geneva, Switzerland on the 23rd May was attended by GSU colleagues from the University of Birmingham who were able to join peers within the arena of surgical care at the GSF side event. The side event at the GSF 76th World Health Assembly looked at 'Strengthening Health Systems through upscaling Surgical Care' with participation from a multitude of countries including Croatia, Ecuador, Japan, Malaysia, Sierra Leone and Sweden.

The event provided colleagues from the GSU the opportunity to gain valuable insight into the current landscape of implementing surgical care systems on a global scale whilst also enabling the team to discuss pathways for the Unit to have completed research impact on international healthcare policy. The event hosted by The GSF, along with several co-sponsoring member states, also looked at the role of sustainable financing which is currently seen as a key topic within the delivery of surgical care, particularly in low- and middle-income countries.

You can find out more on how the NIHR GSU is improving global surgical outcomes through collaborative research by clicking here.

Community Engagement and Involvement (CEI) Event in Walipur, Punjab Educates Locals on Wound Management

First educational session held by GSU India Hub for local villagers provided valuable insight into wound control

The event that took place on the 15th May in Walipur, Ayali Kalan, Punjab was part of the India Hub's rollout strategy in engaging rural networks across the country, using evidence generated from across the Unit's portfolio of international trials and studies that included patients from across India.

The audience consisted of predominantly patients and Community Health Workers (non-medically trained frontline health workers who are often the primary point of contact for patient care in India). The discussion focused on the management of a variety of wounds and how they can be treated within a domestic setting using basic tools.

The success of the event resulted in nearby village heads requesting the session to be delivered to their local populations, in addition to the creation a variety of take-home materials that the India Hub team are currently working on. The India team are also planning on providing a Cancer Engagement session next month that will look to take place as part of the team's CEI event rollout strategy for local populations across India.

You can view more information on CEI by clicking here.

You can also view the India Hub page by clicking here.

Paper Highlights Link between Investing in Safe Surgery and Reduced Burden on Healthcare Infrastructure in LMICs

A new paper from the KIWI study demonstrates how investing in health technologies may help reduce the costs associated with Surgical Site Infections (SSIs) for both the patient and low-resource health systems

The Key resource use In Wound Infection (KIWI) study was carried out to estimate the cost burden associated with SSI. The specific objectives of KIWI were to:

  1. Measure the additional within-hospital resource use for patients with SSI compared to patients without SSI
  2. Identify and measure the resource use for patients who have SSI detected after hospital discharge
  3. Explore the relative cost burden for patients with contaminated-dirty operations compared to patients with clean-contaminated surgeries
  4. Explore the healthcare needs and resource use of patients with an unresolved SSI at 30 days and beyond

A total of 335 patients were included in the global study with data collected on postoperative resource use and costs from consecutive patients undergoing abdominal surgery with an incision >5cm (including caesarean section) that were recruited to the FALCON trial between April and October 2020. A mix of both prospective and retrospective data was used which recorded SSI occurrence in 7% of clean-contaminated cases and 27% of contaminated-dirty cases.

Using data from inpatients in India, Mexico, Ghana and Nigeria, researchers were able to conclude that SSI was associated with an increase in postoperative healthcare costs by 75.3% (€412) after clean-contaminated surgery and 66.6% (€331) after contaminated-dirty surgery. The overall mean additional post-operative costs with SSI were higher in clean-contaminated cases compared with contaminated-dirty cases. This led researchers to conclude that investment in health technologies to reduce SSI may mitigate the financial burden to patients and low-resource health systems.

The findings have been published in Journal of Hospital Infection which you can access by clicking here.

You can read the full UoB press release by clicking here.

You can also access additional information on the projects involved by clicking here for KIWI and here for FALCON.

Benin Hub Data Provides Valuable Evidence for Detection of Surgical Site Infections

TALON data enables student from the Faculty of Health Sciences of Cotonou to establish link between detection in Surgical Site Infections (SSIs) and telephone calls made to patients

The link was made in the student's doctoral thesis that looked at the diagnosis of infections of the operating site in abdominal surgery in 3 hospital centres in Benin. Thesis results showed that out of 103 patients surveyed from the 3 hospital sites, just under 8% had an SSI diagnosis made via telephone consultation. This compared to just under 9% receiving a diagnosis from a face-to-face examination.

This is the first time in which the Benin Hub have provided data to enable a student from a partner organisation to conduct their research. The team are hoping that they'll be able to assist more students with data generated through GSU based work and also stated how this relationship demonstrates the impact the hub is having on local healthcare and research based infrastructure.

You can view more on the Benin Hub team by clicking here.

You can also find out more on the TALON Study by clicking here.


GECKO International Study Formally Launches

Global Evaluation of Cholecystectomy (GECKO) will look to define the global variation in compliance to pre-, intra-, and post-operative audit standards

Cholecystectomy is amongst the most common surgical operations performed worldwide yet there is still insufficient evidence around the variations of safe provision of laparoscopic surgery for gallbladder disease internationally, including low- and middle-income countries.

In addition to the primary aim of the study, GECKO will also look at the following:

  1. To determine the quality of safe provision of cholecystectomy, including the rates of: (i)
    achieving a critical view of safety; (ii) intraoperative imaging use (e.g., cholangiogram); and (iii) initiating of different bailout procedures (e.g., subtotal cholecystectomy) when safe
    cholecystectomy is compromised.
  2. To assess adverse events following cholecystectomy (e.g., bile duct injury) and their
  3. To analyse rates and outcomes of unsuspected gallbladder cancer.
  4. To evaluate the global variation in the availability of cholecystectomy services and training
    amongst included hospitals.
  5. To assess sustainable practices in laparoscopic cholecystectomy globally.

The study will span over 8 separate 2 week data collection periods starting 31st July, ending on the 19th November 2023.

You can view the study summary video by clicking here.

You can also view further information on the study by clicking here.


Newly Appointed Ghana Hub Deputy Director Wins Highly Esteemed Award

Dr. Agbeko recently named a fellow of the West Africa Institute of Surgeons where she also received 'Best Candidate in General Surgery' award

The recently appointed Deputy Director for the Ghana Hub (appointed March 2023) is noted as being the only general surgeon with a PhD in palliative care who also holds a Fellowship from the Ghana Institute of Surgeons, amongst her many accolades spanning an extensive career in surgical care.

Dr. Agbeko's interest includes partnerships that foster developing equity in surgical care across the world, especially in low-resourced settings.

The Ghana Hub are also currently in the process of managing data cleaning for the HIPPO study that will soon be closing to new registrations. More details on the HIPPO study can be accessed by clicking here.

You can read more on Dr. Agbeko's career to date by reading the GhanaWeb news article here.

More information on the Ghana Hub team can be accessed here.

Dr. Agbeko

Ghana Deputy Hub Director



Surgical Infection Education Event Held in India Draws Large Audience

Registered Medical Practitioners (RMPs) attended recent meeting that looked at results from the FALCON and CHEETAH trials

The meeting that took place on the 12th April at the Christian Medical College in Ludhiana managed to draw a large audience of RMPs who are usually the first point of contact for the patients in India, especially in rural areas. The main aims of the meeting were:

  1. To appraise the RMPs about the surgical wound care of the patients post-discharge from the hospital
  2. To inform the RMPs of the early signs of Surgical Site Infection (SSI) and its management
  3. To understand the challenges faced by the RMPs in managing surgical wound care and surgical site infection in their practices

Following the presentations that took place, the event team were keen to find out what challenges were faced by RMPs in relation to the provision of surgical wound care, particularly regarding the management of SSIs. Following on from initial discussions that took place in the meeting, the team will be following-up with attendees over the coming weeks to gather further information.

In relation to the CEI programme in India, Atul Suroy (India Hub Manager) was quoted as saying 'With CEI, we aim to empower the existing workforce with evidence-based practices generated through GLOBALSurg collaborative studies to build capacity in the states of India."

You can find out more on the CHEETAH trial by clicking here. Further information on FALCON can be accessed by clicking here.

You can also visit the India national page by clicking here and Community Engagement and Involvement (CEI) in India info slides by clicking here.

Overview of the Rwanda Hub National Steering Committee

Rwanda Spoke groups attend national CEI meeting in Kigali

The aim of the meeting that took place on the 20th April was to involve the community in clinical trial development, in addition to strengthening Community Engagement & Involvement (CEI) structure in Rwanda. The meeting gave members the opportunity to collectively meet face to face for the first time since the inception of the hub. In Rwanda each spoke group consists of roughly 6 - 8 members with 2 co-chairs (inclusive) consisting of a member of the hub team and member of the community.

During the meeting the committee were able to provide valuable input into the SWANN, PROTECTSurg and DRAGON national trials. Members were also given the opportunity to comment on the provision of post-operative care provided by community healthcare workers through the PIGEON project.

The meeting also enabled members to elect the National CEI Group that will form part of an international committee of representatives from each partner country within the GSU unit.

You can view the official CEI brochure for Rwanda (in Kinyarwanda) by clicking here.

You can also visit the Rwanda Hub page by clicking here or CEI page by clicking here.