Global Surgery Research
The NIHR Global Health Research Unit on Global Surgery
Improving surgical outcomes through collaborative research
Research to support safe surgery is urgently needed to ensure that the benefits of surgical care are realised across the world and the risk of adverse outcomes minimised.
The GSU run a variety of international research projects that can be accessed through the links below.
Research Milestones include:
- FALCON Randomised Controlled Trial: completed in 21 months, 15 months ahead of schedule even through the global pandemic, published in LANCET (Oct 2021).
- 64 clusters have been randomised and activated in the CHEETAH study. Patient recruitment to be completed in early 2022
- Delivery of 5 annual workshops (South Africa 2017, Rwanda 2018, Ghana 2019, online 2020, Ghana 2021)
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.
Global Surgery - Our Teams
The NIHR Global Health Research Unit on Global Surgery
Improving surgical outcomes through collaborative research
To run research on a global scale requires the hard work and dedication of a truly global team – here’s the amazing team who make the NIHR Global Health Research Unit on Global Surgery and GlobalSurg projects a reality!
The NIHR Global Health Unit on Global Surgery
The NIHR Global Health Research Unit on Global Surgery is a consortium between UK Universities of Birmingham, Edinburgh & Warwick together with our international partners at hubs and centres around the world
Unit Directors
Professor Dion Morton OBE
Co-Director
Professor Stephen Tabiri
Co-Director/ Hub Lead
University of Birmingham
Mr Aneel Bhangu
NIHR Clinician Scientist
Miss Rhianna Parsons
Programme Manager
Dr Audrey Nganwa
Project Manager
Mr Edward Bywater
Project Officer
Ms Belinda San
Project Officer
Mr Brett Dawson
Data Manager
Mr Michael Bahrami-Hessari
Patient, Public and Community Involvement and Engagement Manager
Dr Laura Magill
Senior Lecturer in Clinical Trials
Professor Thomas Pinkney
George Drexler & Royal College of Surgeons Chair of Surgical Trials
Ms Rachel Lillywhite
Team Leader – Global Surgery Trials
Ms Donna Smith
Senior Trial Manager
Mrs Divya Kapoor
Senior Trial Manager
Mr James Keatley
Project Manager
Dr James Glaseby
Clinical PhD Fellow
Dr Joana Simoes
Clinical PhD Fellow
Dr Elizabeth Li Yan
Clinical PhD Fellow
Dr Harvinder Mann
Clinical PhD Fellow
Dr Sivesh Kathir Kamarajah
Clinical PhD Fellow
Dr Maria Picciochi
Clinical PhD Fellow
Dr Dimitri Nepogodiev
PhD Fellow
Professor Richard Lilford
Professor of Public Health
Professor Tracey Roberts
Professor of Health Economic and Head of Health Economics Unit
Mr Mwayi Kachapila
Research Associate in Health Economics
Mr Bryar Kadir
Senior Statistician
Dr Omar Omar
Senior Statistician & Epidemiologist
Ms Felicity Brant
Senior Data Manager
University of Edinburgh
Professor Ewen Harrison
Professor of Surgery and Data Science
Dr Katie Shaw
Programme Manager
Dr Riinu Ots
Senior Data Manager
Dr Stephen Knight
Clinical Research Fellow
Dr Lisa Norman
Research Assistant
Dr Tom Drake
Clinical Research Fellow
NIHR Global Surgery Unit International Hubs & Centres
Global Surgery - Who We are
GlobalSurg & The NIHR Global Health Research Unit on Global Surgery
Improving surgical outcomes through collaborative research
The Unit is built upon equitable partnerships between all members. Through an evolving shared leadership with the Hub Directors, structured transfer of leadership to the Hub Directors provides sustainability for the Hubs, the network and thereby the Unit.
Our research is undertaken through a network of >80 Hub-Spoke hospitals, located across three continents.
Over the last 4.5 years, we have set up seven surgical research Hubs in Benin, Ghana, India, Mexico, Nigeria, Rwanda and South Africa with an extensive network of urban and rural ‘Spoke’ hospitals. This network prioritised the surgical topics that needed research and has performed multiple surgical studies.
Through bespoke training we are building capacity across this network to undertake surgical and other clinical research.
Global Surgery - About Us
GlobalSurg & The NIHR Global Health Research Unit on Global Surgery
Improving surgical outcomes through collaborative research
In 2015 The Lancet Commission and WHO identified that 5 billion people lack access to safe, affordable surgical and anaesthesia care. We estimate that approximately 4.2 million people will die each year within 30 days of surgery – more than from all causes related to HIV, malaria, and tuberculosis combined A critical need exists to reduce inequalities in surgical care throughout the world.[link to publication].
The NIHR Global Health Research Unit on Global Surgery (GSU) has worked with international partners to launch research networks across sub-Saharan Africa, the Indian sub-continent, South East Asia and Central America with the aim to improve surgical outcomes for patients through collaborative research and by building surgical research capacity in LMICs.
NIHR Global Surgery Unit International Hubs & Centres
Global Surgery - Community Engagement
GlobalSurg & The NIHR Global Health Research Unit on Global Surgery
Improving surgical outcomes through collaborative research
For GSU, this means working closely with community stakeholders in our LMICs. These stakeholders might be patients and their families, community leaders or generally anyone in the community affected by our surgical research.To achieve this, we have developed the below outlined overarching CEI strategy – a flexible approach to reaching and establishing ongoing relationships with relevant community members.
Community Engagement and Involvement (CEI) at GSU
“…the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people”
– US Centers for Disease Control and Prevention
The key building blocks are:
1. Each Hub employs a CEI Lead (e.g. a research nurse), who has been trained in best practice CEI according to the UNICEF standards and is responsible for recruitment, training and ongoing support of the community representatives
2. The community representatives are well-connected key stakeholders with reach into grassroots communities
3. The Hub CEI Lead and community representatives meet regularly to form the (virtual) CEI steering committee
4. The steering committee allows us to reach those in the community who are most affected by our research and ensurse they are empowered to contribute towards decision-making
All CEI activities are being captured and evaluated by the UK-based CEI Coordinator, who is also responsible for training, monitoring and shared learning.
Our CEI Case Studies
Our case studies showcase practical application of CEI in LMIC settings with focus on exploring best practice and highlighting challenges and barriers, as well as potential solutions. Learn about the tailored CEI activities.
THE TIGER STUDY
Task-shifting inguinal hernia repair between surgeons and non-surgeon physicians in rural Ghana.
THE STARFISH STUDY
Stoma Care For Improvement Research: Epidemiologic study of stoma cases in The Philippines and qualitative research on the challenges of stoma care.
Images from our Community Engagement Projects
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Global Surgery - Cohort Studies
GlobalSurg & The NIHR Global Health Research Unit on Global Surgery
Improving surgical outcomes through collaborative research
GlobalSurg is an international collaboration of surgical researchers including you!Our international cohort studies aim to give grass-root surgeons the opportunity to participate in major projects. They will lack complexity and will not require extra resources or funding.
GlobalSurg International Cohort Studies
Every collaborator who contributes to data collection in a GlobalSurg cohort study will be a PubMed citable co-author on the final paper; we will aim for a high impact factor surgical journals and, where possible, ensure our papers are open access. You can see examples of our publication model in our published papers available on our publications page
GlobalSurg cohort projects will be designed to ensure they are easy for local surgeons to execute and will act as a hypothesis generating observational tool for future global research studies, including the opportunity for randomised trials.
You can read about our past cohort studies, GlobalSurg 1 and GlobalSurg 2 on the project hub pages
Any hospital in the world performing acute general surgery can participate
Individuals can participate as local collaborators or regional/country leads
What is your role?
Local Collaborators
At each centre, local investigators can form a team of up to 3 people (including themselves) to accurately perform patient identification and data collection. Local investigators will be specifically responsible for:
- Gaining local audit or research approval
- Ideally forming a team of 2-3 people (including themselves) to identify patients and collect data (team names submitted with final data).
- Creating clear mechanisms to identify and include eligible patients
- Identifying clear pathways to establish outcome
Regional/National Leads
National coordinators are encouraged to spread the protocol to interested colleagues in different hospitals. Each coordinator is asked to deliver at least 10 participating centres. Multiple sub-coordinators per country working together are also encouraged, especially in larger countries. Coordinators are allowed to translate the protocol for dissemination where appropriate. The extra efforts of these people will be clearly identified in a separate section of final manuscripts.
Images from The International Cohort Studies
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Global Surgery - Clinical Trials
GlobalSurg & The NIHR Global Health Research Unit on Global Surgery
Improving surgical outcomes through collaborative research
In order to change practice and improve outcomes for surgical patients, the highest quality evidence that a treatment is effective is required. This level of evidence can only be generated in the setting of high quality international, multi-centre randomised controlled trials.
Clinical trials are highly complex and regulated and therefore will be conducted only in NIHR Unit on Global Surgery hub countries.
Each hub will enrol patients into trials and will work with other hospitals within their country to ensure a good mix of participating centres from tertiary referral units through to rural community hospitals in remote settings.
If your hospital is in an NIHR Unit on Global Surgery hub country and you would be interested in taking part in a GlobalSurg clinical trial, please contact your nearest hub via our contacts page.
Over 5 billion people around the world lack access to safe affordable surgical care”
The Lancet Commission 2017
... But we are making a difference
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GlobalSurg 1
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GlobalSurg 2
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GlobalSurg 3
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PROTECT SURG TRIAL
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.
FALCON TRIAL
The FALCON trial looks into the prevention of surgical site infections (SSI) in low- and middle- income countries.
The health economics sub-study within FALCON is named KIWI (Key Resource Use In Wound Infection).
Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences .Previous studies in LMICs on the costs of SSI have been limited by small sample size single-centre hospitals which did not capture costs occurring after hospital discharge. The lack of follow up is a problem as SSI can occur after discharge and costs associated with SSI have been shown to persist beyond 30 days. The main FALCON trial is assessing different treatment combinations to reduce Surgical Site Infection (SSI). The FALCON KIWI sub study is assessing the resource use and costs for patients with and without SSI across several hub countries.
KIWI STUDY
The FALCON KIWI sub study is assessing the resource use and costs for patients with and without SSI across several hub countries. KIWI includes resource use collection (via additional CRFs) up to the 30-day follow-up assessment for patients and extended follow-up for any patients with an ongoing wound infection up to 60 days post-surgery.’
CRANE STUDY
CRANE is a feasibility study of a nutritional intervention to improve outcomes after cancer surgery in low-income countries. It aims to identify and validate a nutritional screening tool; identify a low cost sustainable nutritional intervention; and investigate recruitment and retention, data collection methods and the acceptability of a nutritional intervention to improve outcomes after cancer surgery in low- and middle-income countries.
The health economics component looks at the feasibility of collecting economic data and the design of resource use forms for a full trial. The health economics is particularly important essential given the importance of cost effectiveness in developing a long term sustainable solution.
PENGUIN TRIAL
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.
EAGLE STUDY
The ESCP Safe-anastomosis Programme in Colorectal Surgery (EAGLE) is an international, cluster randomised-sequence study of a Safe-anastomosis Quality Improvement Intervention to reduce anastomotic leak following right colectomy and ileocaecal resection
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.
CHEETAH TRIAL
The main CHEETAH trial is assessing whether the practice of using separate, sterile gloves and instruments to close wounds at the end of surgery can reduce surgical site infection at 30-days post-surgery for patients undergoing clean-contaminated, contaminated or dirty abdominal surgery, compared to current routine hospital practice.
Using information from FALCON KIWI and primary data collection in CHEETAH, the cost-effectiveness of the changing gloves/instruments prior to wound closure compared to current routine hospital practice will be assessed.
CROCODILE STUDY
‘Little is known about colorectal cancer treatment delivery in India and the associated costs. CROCODILE aims to identify financial and non-financial barriers for colorectal cancer treatment compliance in India.’
FEATHER STUDY
More information coming soon.
LION STUDY
LION (LaparoscopIc Versus Open Appendectomy): Cost comparison in a lower- middle income setting
This study aims to compare the outcome and cost of conventional open and laparoscopic appendectomy for clinically confirmed, uncomplicated, acute appendicitis in a low resource setting. Although the cost effectiveness of laparoscopic surgery has been investigated previously in high human development index (HDI) countries, similar studies are lacking in low and middle HDI countries.
Led by Dr Adewale Adisa at the NIHR hub in Nigeria, this study will compare outcomes following open and laparoscopic appendectomy in approximately 150 patients at 3 hospitals in Nigeria.
STARFISH TRIAL
SToma cARe For Improvement reSearcH (STARFISH): Epidemiologic study of stoma cases in Lower- and Middle-Income Countries and qualitative research on the challenges on stoma care.
The STARFISH study uses a mixed methods approach to assess the burden and challenges of stoma care in low and middle income settings.
Based at the Unit’s Centre in the Philippines and led by Dr Maria Carmela Lapitan at the University of the Philippines in Manilla, Starfish comprises 3 separate sub-studies:
1. A survey at selected healthcare facilities to collect data on stoma incidence, types, indications and complications.
2. Focus groups and one-to-one interviews with patients, carers and health care providers involved in stoma care
3. Development of a questionnaire for stoma patients in low and middle income settings to collect standardised data on stoma care
TALON STUDY
TALON is a sub-study embedded in the FALCON and CHEETAH trials, run as part of an NIHR Doctoral Research Fellowship in Global Surgery. The aim of the sub-studies is to improve the quality and efficiency of surgical trial methodology across low- and middle-income countries.
ACCESS STUDY
The majority of the world’s population lack access to timely hospital care. In low & middle income countries, 98% of patients lack access to safe, affordable surgical care.
Those that do reach hospital often experience delays in their care, contributing to the observed increased death rates in LMICs.
TIGER STUDY
TIGER (Task shifting Inguinal hernia Repair between surgeons and technicians): development of a randomised trial in low and middle income countries
Can technicians perform mesh inguinal hernia repair safely and cost-effectively in rural surgical settings in low and middle income countries?
This pilot trial aims to investigate delivery of a standardised, measurable training programme for technicians to perform a mesh inguinal hernia repair.
BURNS TRIAL
Burns are a significant contributor to the burden of disease in low- and middle-income countries (LMIC). Although current guidelines recommend treatment in specialized treatment centres, such centres are few or non-existent in many LMIC settings.
This study is a prospective observational study comparing outcomes of burns treatments between non-specialised and specialised burns units.
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.