Prioritizing research for patients requiring surgery in low- and middle-income countries

Abstract

Background The National Institute for Health Research Global Health Research Unit on Global Surgery is establishing research Hubs in low‐ and middle‐income countries (LMICs). The aim of this study was for the Hubs to prioritize future research into areas of unmet clinical need for patients in LMICs requiring surgery. Methods A modified Delphi process was overseen by the research Hub leads and engaged LMIC clinicians, patients and expert methodologists. A four‐stage iterative process was delivered to prioritize research topics. This included anonymous electronic voting, teleconference discussions and a 2‐day priority‐setting workshop. Results In stage 1, Hub leads proposed 32 topics across six domains: access to surgery, cancer, perioperative care, research methods, acute care surgery and communicable disease. In stages 2 and 3, 40 LMICs and 20 high‐income countries participated in online voting, leading to identification of three priority research topics: access to surgery; outcomes of cancer surgery; and perioperative care. During stage 4, specific research plans to address each topic were developed by Hub leads at a priority‐setting workshop. Conclusion This process identified three priority areas for future research relevant to surgery in LMICs. It was driven by front‐line LMIC clinicians, patients and other stakeholders representing a diverse range of settings. The results of the prioritization exercise provide a future framework for researchers and funders.

Study protocol for a cluster randomised trial of sterile glove and instrument change at the time of wound closure to reduce surgical site infection in low- and middle-income countries (CHEETAH)

“…Recent World Health Organization (WHO) guidelines made 29 recommendations for measures to prevent SSI, but there was little high-quality evidence to support most of these interventions [ 10 , 11 ]. A Delphi consensus was undertaken by an international panel of surgeons to identify the WHO recommendations in greatest need of better supporting evidence [ 12 ]. The WHO recommendations for change of gloves and sterile instruments at the time of fascial closure were identified as the priority recommendations.…”

Feasibility and diagnostic accuracy of Telephone Administration of an adapted wound heaLing QuestiONnaire for assessment for surgical site infection following abdominal surgery in low and middle-income countries (TALON): protocol for a study within a trial (SWAT)

“…The global burden of morbidity as a result of surgical infection has dramatic and wide-reaching effects on patients, providers, and health systems in LMICs [14,61,62]. SSI has therefore been recognised as the highest global priority in surgical research and is therefore a natural target for the TALON study [7,63]. Future work will be required to standard processes for outcome assessment across other common and severe postoperative complications [64].…”

“…Reported rates vary, but SSI is particularly prevalent in abdominal and colorectal surgery; as many as one in three patients get an SSI when the operation involves the large bowel [6]. It was highlighted as the key research priority to improve surgical care worldwide in an international prioritisation process [7] and is the focus of several ongoing global randomised trials [8][9][10][11].…”

Antibiotic prophylaxis in a global surgical context

“…Surgical site infection (SSI) is a global problem, and has been highlighted as the foremost research priority for perioperative researchers across high-, middle-and low-income settings. 1 Depending on the degree of intraoperative contamination, baseline patient risk and other infection control measures, as many as 50% of patients can suffer surgical wound infections within the 30-days after an operation. 2 As a result, SSI has been the focus of several recent global initiatives including randomised controlled trials of health technologies, 3 quality improvement bundle studies, [4][5][6] and prospective cohort studies.…”