The NIHR Global Health Research Unit on Global Surgery

Improving surgical outcomes through collaborative research

Many clinical guidelines are developed by high‐income country institutions with little consideration given to either the evidence base for interventions in LMICs, or the specific challenges LMIC health systems may face in implementing recommendations. Through a Delphi exercise, the GSU prioritised topics for global surgery guideline development and work was undertaken across the research Hub network to develop top prioritised guidelines. The results of the Delphi exercise were reported in BJS. A key aspect of the work we do revolves around the notion of informing national guidelines through reaching for example national surgical societies and health service providers. With our hub directors, we have established a consensus process for refining rationalised ‘Essential Surgical Guidelines’ to support care delivery across LMICs. In response to COVID-19, for example, a range of related projects international including surgical guidelines have been undertaken and published.

Global Surgical Guidelines for Prevention of Surgical Site Infections

Surgical site infection (SSI) is the commonest postoperative complication in abdominal surgery. SSI causes patients to experience pain and delays return to normal activities such as work. Additional SSI-related health costs can cause financial hardship, particularly for the most vulnerable patients in LMICs. Treatment of SSI is increasingly challenging due to the rise of antibiotic resistance, which occurs in up to 46% of LMIC patients. This places a strong focus on preventing SSI from occurring in the first place.

We have worked with surgeons representing 13 LMICs to collaboratively adapt existing high income country guidance to produce a guideline that reflects the challenges of delivering surgery in LMICs, and allows health providers to prioritise implementation of key interventions that are most likely to benefit patients.

The ‘Global Surgery Guideline for the Prevention of Surgical Site Infection’, published in BJS, has identified practical steps that all hospitals should urgently take to both reduce avoidable infections and the spread of antimicrobial resistance. In addition, a further three ‘desirable’ recommendations are made in the guideline. It is recognised that worldwide some hospitals may lack the necessary resources to immediately implement these interventions, in which case they should plan strategies to introduce these interventions in the future.

Global Guidance for Surgical Care During the COVID-19 Pandemic

Global Covid19 Guidance - Part 1
Global Covid19 Guidance - Part 2

Global Guidance for surgical care during the COVID-19 pandemic

Surgeons worldwide urgently need guidance on how to deliver surgical services safely and effectively during the COVID-19 pandemic. The key outcomes from a scoping search conducted to identify published articles relating to management of surgical patients during pandemics are published in the BJS and outlined in the poster below.

Bringing together surgeons, researchers and policy makers to set the local research agenda according to patient need in LMIC and ensuring all patients have the opportunity to take part in our research.