The NIHR Global Health Research Unit on Global Surgery

Improving surgical outcomes through collaborative research

Perioperative care is an umbrella term that includes every stage of a patient’s journey from the time they are identified for an operation, to the time they are discharged from hospital. The GSU currently runs various trials, including PENGUIN, PROTECT Surg and GIRAFFE’. Further information on each individual trial and how they are helping to improve healthcare quality on an international scale can be found by clicking on the study links below.

Perioperative Care Research


Surgical patients are at high risk of exposure to respiratory infection transmissions including coronavirus disease (COVID-19) and other complications. Despite this, some surgeries especially non-elective ones have to be performed even during the pandemic period which will likely increase post-operative pneumonia cases, hospital resource use and mortality rates.

The PROTECT Surg Trial has been planned to estimate the impact of interventions hypothesised to avert postoperative pulmonary complications during the COVID-19 pandemic. It is an international multicentre adaptive trial which will establish as quick as possible beneficial interventions, drop interventions with no evidence of effectiveness and introduce new interventions with potential of reducing pulmonary complications during the COVID-19 pandemic. In the initial design, the trial will assess the effectiveness of three interventions compared to normal practice (no trial drug): (1) lopinavir-Ritonavir (2) hydroxychloroquine and (3) a combination of Lopinavir-Ritonavir and hydroxychloroquine.

Project Penguin


The PENGUIN trial is a 2 x 2 factorial, international pragmatic randomised trial. The trial aims to assess whether preoperative chlorhexidine mouthwash when compared to no-mouthwash-surgery can reduce incidence of post-operative pneumonia (POP) and whether perioperative liberal oxygen versus restrictive oxygen can reduce incidence surgical site infections (SSI) at 30-days among abdominal surgery patients.

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Studies- GSU - Giraffe


GIRAFFE (a patient-blinded, international, multicentre, cluster-sequence, randomised controlled study) uses an on-line education/training tool to improve in-theatre performance and perioperative care of patients undergoing emergency laparotomy and thereby seek to reduce postoperative hospital deaths.

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" 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. "