Safe and affordable surgery is a global health priority. For surgical procedures to effectively improve patient outcomes, health systems must also provide high-quality perioperative care.
There is now strong evidence that health systems failures around the time of surgery are a key factor limiting the net improvements in health which could be achieved through greater access to surgery worldwide.
Professor Pearse and Tim Stephens lead the interdisciplinary global health research within our group. Improving perioperative care globally through research is a truly a collaborative effort and we have partnerships with academic institutions in Uganda, South Africa, Tanzania, Sri Lanka and Colombia. We also work closely with the GlobalSurg group, working out of the University of Birmingham. We currently have two PhD students from LMICs in our group.
African Surgical Outcomes Study 2 (ASOS-2)
The landmark ASOS study identified that surgical mortality in LMICs is twice that of high-income countries, despite the surgical population being younger with less co-morbid disease. ASOS-2 is an international African, multicentre, cluster randomised trial of a complex intervention to reduce mortality after surgery. Professor Rupert Pearse is part of the trial leadership group and Tim Stephens is leading the mixed-methods process evaluation of the trial.
PErioperative Respiratory care and Outcomes for patieNts underGoing high risk abdomINal surgery trial (PENGUIN)
Pneumonia and surgical site infections are the most common complications following surgery across the world, placing significant financial costs on healthcare systems. The increased costs can be a major problem in countries with lower incomes where patients often pay for their own treatment. PENGUIN is a global randomised clinical trial. Funding = National Institute for Health Research (NIHR).
Family SuppleMented pAtient monitoRing afTEr surgery (SMARTER) trial (formerly P-CALM)
Multiple studies, including work from our group and collaborators have identified failure to rescue as a major contributor to post-operative mortality in LMICs. Surgical mortality is twice that of high-income countries, increasing to 50-fold for procedures such as caesarean section. The SMARTER trial is a single centre, cluster randomised trial of a task shifting intervention that will enhance post-operative surveillance for patients. Funding = National Institute of Academic Anaesthesia. PI = Adam Hewitt-Smith.
Mixed methods study of mortality after maternal haemorrhage in Uganda
Maternal haemorrhage is the leading cause of death during childbirth worldwide, with over 94,000 women dying per year in LMICs as a result. Survivors face complications that place a huge burden on families, communities, and fragile health systems. This is a six-month, prospective, mixed-methods study of the causes of maternal haemorrhage in Uganda, collecting a range of data to understand delays in seeking maternal care, accessing care and time to key in-hospital interventions. Funding = GCRF Large Grant (QMUL). PI = Fred Bulamba.