NIHR Global Health Group on Perioperative and Critical Care

BACKGROUND

More than 600,000 patients die after surgery in Africa each year, a death rate which is twice the global average. Patients who survive complications still experience reduced life expectancy, reduced quality of life and financial hardship. Poor patient outcomes primarily result from failings in perioperative and critical care (before, during and after surgery) rather than surgery itself.

Meanwhile, a three-fold increase in procedures is required to meet the needs of 1.2 billion people across Africa who cannot access safe and affordable surgical treatments. As health systems work to increase the volume of surgical activity, we anticipate an equivalent increase in complications and deaths after surgery. To improve patient safety and outcomes, whilst increasing the volume of surgery in Africa, we must develop solutions tailored to the needs of these varied perioperative health systems.

Without effective perioperative and critical care, the positive impact of increased provision of surgery will be limited, as will any net improvements in health. WORK TO DATE

The African Perioperative Research Group (APORG) of 705 hospitals in 42 countries has a strong track-record delivering high-impact applied research including pilot studies, mixed-methods research, and large international epidemiological studies and clinical trials. AIM

To create centres of research excellence in four African nations within APORG to deliver an international research programme and improve the safety and effectiveness of perioperative and critical care across Africa. METHODS

Objective 1: Consolidate managerial, finance and governance infrastructure to strengthen existing partnerships and establish centres of research excellence in four African universities with a research methodology centre to design and lead international clinical trials, providing sustainable capacity and capability in research delivery and leadership.

Objective 2: Deliver a programme of high-impact research consisting of international observational and mixed-methods studies, epidemiology and large clinical trials to develop and test context-specific complex interventions addressing locally identified needs across four themes: 1) Developing realistic and sustainable models of Essential Critical Care

2) Improving identification of critically ill patients after surgery 3) Preventing and treating life-threatening perioperative maternal haemorrhage

4) Building and linking national digital health systems to evaluate the impact of Projects 1 to 3 on patient outcomes after surgery through international clinical audit and epidemiological research

Objective 3: Establish a Community Engagement & Involvement (CEI) team with links to civil society, policy-makers and health professionals across partner nations to co-produce complex interventions, support delivery of patient relevant research and develop pathway-to-policy impact plans. Timeline Year 1 Complete pilot & mixed-methods studies; Recruit and train research staff; Establish CEI teams

Year 2 Analyse preliminary data; Co-produce interventions for major trials Year 3 Launch clinical trials; Analyse perioperative registry data Year 4 Complete clinical trials; Plan sustainable future for APORG IMPACT

Our research will inform practice and policy changes which could reduce surgical mortality to the global average across Africa, saving 300,000 lives each year, improving long-term health and reducing financial hardship.