Surgeons must tackle three global health challenges to save lives

Despite significant advances over the last 30 years, surgical research is still limited to comparing the benefit of one technique over another. It can be founded on assumptions that a new device or approach is always better - leading to poorly evaluated devices and procedures having negative effects on patients.

Writing in The Lancet, experts from the NIHR Global Health Research Unit for Global Surgery GlobalSurg Collaborative – a programme backed by funding from the NIHR (National Institute for Health and Care Research) – propose three priority areas for surgery:

• Access, equity, and public health must be recognised as crucial issues for surgery.

In 2015, five billion people did not have access to safe and affordable surgical care[1]. Of those who did, 33 million individuals faced catastrophic health expenditure in payment for surgery and anaesthesia. During the COVID-19 pandemic, over 28 million cases of elective surgery are likely to have been cancelled. Surgery has a key role in addressing the most important and growing global health challenges, such as trauma, congenital anomalies, safe childbirth, and non-communicable diseases.

• Inclusion and diversity must improve in both surgical research and the profession.

Women, minoritised groups, and patients from low-income and middle-income countries remain under-represented in clinical practice and major research work. Advancing inclusion and diversity will ensure a research agenda that delivers pragmatic, simple, and context-specific research that reflects the needs of all patients.

• Climate change is the greatest global health threat facing the world.

Surgical theatres are some of the most energy and resource intense areas of a hospital. Surgical practice relies on many single-use, non-biodegradable products as well as anaesthetic gases that have a large environmental footprint. Moving towards net-zero operating practices could reduce health-sector carbon emissions and allow surgeons and policy makers to reassess how surgery fits into a wider health system.

Comment co-author Dmitri Nepogodiev, from the University of Birmingham, said: “Richard Horton, Editor-in-Chief of The Lancet, once described surgical research as ‘a comic opera performance’. That was in 1996 and things have changed significantly since then.

“However, truly improving lives requires surgical researchers to use the next quarter of a century to tackle the most pressing questions on equity and access, the role of surgery in public health, and sustainability.

“Despite the problems of large waiting lists and an economic squeeze on health systems, surgeons must focus on these priority areas - placing surgery as a leader in medical specialties and demonstrating its value as a fundamental element of universal health care.”

The experts note that large, randomised controlled trials with well-defined endpoints are now more usual in surgical research, whilst exploration into the placebo effect, has led to a fundamental re-examination of the benefits of some surgical procedures and whether they benefit patients at all.

Surgeons and anaesthetists have developed successful international collaborative research efforts that have enabled rapid recruitment of participants and globally relevant studies and trials, while following internationally set standards of clinical trial practice.  Surgeons can now provide reliable answers to crucial questions in operative surgery, and their research has improved patient care and resource use in health systems.

ENDS

For more information, please contact Tony Moran, International Communications Manager, University of Birmingham on +44 (0) 121 414 8254 or  +44 (0)782 783 2312 or t.moran@bham.ac.uk. For out-of-hours enquiries, please call +44 (0) 7789 921 165.

Notes to Editors

• The University of Birmingham is ranked amongst the world’s top 100 institutions, its work brings people from across the world to Birmingham, including researchers and teachers and more than 8,000 international students from over 150 countries.
• ‘Surgical research—comic opera no more’ - Jessamy Bagenal, Naomi Lee, Adesoji O Ademuyiwa, Dmitri Nepogodiev, Antonio Ramos-De la Medina, Bruce Biccard, Marie Carmela Lapitan, and Wangari Waweru-Siika is published in The Lancet.
• Participating institutions include the University of Birmingham; Lagos University Teaching Hospital, Nigeria; Hospital Español de Veracruz, Mexico; Groote Schuur Hospital and the University of Cape Town, South Africa; University of the Philippines Manila and Philippine General Hospital, Manila; Aga Khan University, Nairobi, Kenya; and Teaching Hospital, Tamale, Ghana.

About the National Institute for Health and Care Research

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

•         Funding high quality, timely research that benefits the NHS, public health and social care;

•         Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;

•         Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;

•         Attracting, training and supporting the best researchers to tackle complex health and social care challenges;

•         Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;

•         Funding applied global health research and training to meet the needs of the poorest people in low- and middle-income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low- and middle-income countries is principally funded through UK Aid from the UK government.

[1] The Lancet Commission on Global Surgery 2030