Experts in Dubai finalise surgical guidelines that will save thousands of lives

University of Birmingham research experts gathered medical professionals from around the world in Dubai to finalise international surgical guidelines that will help to save thousands of lives in Low- and Middle-income Countries (LMIC) countries.

The National Institute for Health Research Global Health Research Unit on Global Surgery (NIHR GHRU) gathered experts to finalise International Guidelines on Surgical Site Infection – essential guidance that will help standardise and improve practice in surgery.

Surgical professionals travelled to Dubai from Mexico, India, South Africa, Ghana, Nigeria, Rwanda, Benin, Zambia, Philippines and Pakistan.

In LMICs, 9 out of 10 people lack access to even the most basic surgical services; six million will die each year within 30 days of an operation and failure to improve surgical care will cost the world economy $12.3 trillion in lost GDP by 2030.

The guidelines are designed to produce clear evidence-based recommendations that can be applied across a range of surgical settings covering pre-operative preparation and in-theatre interventions to reduce the risk of surgical site infection. The guidance will be published later this year in a leading medical research journal.

Professor Dion Morton, Barling Chair of Surgery at the University’s Institute of Cancer and Genomic Sciences, and Co-director of the NIHR GHRU, commented: “There is a critical need to improve worldwide surgical care, through growing capacity, quality and innovation we can transform patient lives.

“High-quality research and training are crucial to building sustainable surgical infrastructure and improving care in LMICs. Our aim is to improve surgical outcomes through collaborative research and training in these countries.

“These new guidelines will help to change surgical practice and improve patient care around the world – saving thousands of lives and helping to reduce the massive loss to the world economy that would result from failing to improve surgical care.”

The meeting followed a University of Birmingham-led conference in Kigali, Rwanda, November last year, where experts came up with 31 evidence-based recommendations identified from existing high-income country Surgical Site Infection guidelines.

This initial list was reduced and revised down to 19 recommendations, which were put to an online vote by LMIC surgeons. Participants voted based on whether each recommendations was appropriate to their setting, current practice and whether implementation would be easy or difficult.

Conference participants in Dubai reviewed results of the online voting and decided which of the 19 recommendations were accepted into the final guidelines – classifying each as 'essential' (a reasonable expectation for all hospitals worldwide) or 'desirable'.

Launched with partners from LMICs, Universities of Edinburgh and Warwick, the NIHR GHRU is establishing hubs and/or trial centres in partner countries that perform their own clinical research relevant to local populations, whilst serving global needs.

The Unit is based at the University of Birmingham and co-directed by Professor Dion Morton, Barling Chair of Surgery and Professor Peter Brocklehurst, Director of the Birmingham Clinical Trials Unit.

Partners in the Unit have also formed a Policy and Implementation Consortium to work with professional associations, NGOs and government organisations across the world, including the World Health Organisation. This Consortium will use the results from the research generated by the Unit as a tool to inform changes in clinical practise and provide evidence to drive policy changes across the globe.

• 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 6,500 international students from over 150 countries.
• NIHR Global Health Research Unit works with partner institutions in a range of Low and Middle Income countries, including:

• Ghana - University of Development Studies, Tamale
• Nigeria - Lagos University Teaching Hospital, Lagos
• Rwanda - University of Rwanda; University Teaching Hospital, Kigali
• South Africa - Chris Hani Baragwanath Academic Hospital, Johannesburg
• Mexico - Hospital Espanol, Veracruz
• Pakistan- King Edward’s Medical University, Lahore
• Benin - University of Abomey-Calavi, Cotonou
• Phillipines - Philippine General Hospital University, Manila
• Zambia Ndola Teaching Hospital, Ndola
• India – CMC Ludhiana, Punjab

• The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health, the NIHR funds high quality research to improve health, trains and supports health researchers, provides world-class research facilities, works with the life sciences industry and charities to benefit all and involves patients and the public at every step.
• The NIHR is the nation's largest funder of health and care research. The NIHR:

Funds, supports and delivers high quality research that benefits the NHS, public health and social care
Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

• The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low and middle-income countries, using Official Development Assistance funding.
• NIHR initially awarded £7 million to the Universities of Birmingham, Edinburgh and Warwick to establish the NIHR Global Health Research Unit on Global Surgery at the University of Birmingham. It is one of 53 research units and groups announced funded by £120 million from NIHR’s Global Health Research initiative which has given UK-based universities and research institutes the opportunity to develop and expand their existing global health work.
• Over a period of four years, until March 2021, the NIHR Global Health Research Unit on Global Surgery will establish sustainable international research hubs across a range of low and middle income countries.
• Working in partnership with the Royal College of Surgeons, relationships have been developed with local hospital networks, governmental ministries of health, industry and non-governmental organisations in order to set up pathways to rapidly translate research findings in to evidence-based patient care.