Title: NIHR Global Health Group on Perioperative and Critical Care
Funder: Department of Health and Social Care

Abstract: BACKGROUND_x000D_ 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._x000D_ _x000D_ WORK TO DATE_x000D_ 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._x000D_ _x000D_ AIM_x000D_ 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._x000D_ _x000D_ METHODS_x000D_ 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._x000D_ _x000D_ 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:_x000D_ 1) Developing realistic and sustainable models of Essential Critical Care_x000D_ 2) Improving identification of critically ill patients after surgery_x000D_ 3) Preventing and treating life-threatening perioperative maternal haemorrhage_x000D_ 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_x000D_ _x000D_ 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._x000D_ _x000D_ Timeline_x000D_ Year 1 Complete pilot & mixed-methods studies; Recruit and train research staff; Establish CEI teams_x000D_ Year 2 Analyse preliminary data; Co-produce interventions for major trials_x000D_ Year 3 Launch clinical trials; Analyse perioperative registry data_x000D_ Year 4 Complete clinical trials; Plan sustainable future for APORG_x000D_ _x000D_ IMPACT_x000D_ 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.

Lay abstract: AIM_x000D_ To develop centres of research excellence in four African nations within the African Perioperative Research Group (APORG) of 705 hospitals in 42 countries, creating equitable partnerships to deliver an international research programme and improve the safety and quality of perioperative and critical care across Africa._x000D_ _x000D_ BACKGROUND_x000D_ More than 600,000 patients die after surgery in Africa each year, a death rate which is twice the global average. Those patients who develop complications after surgery but survive, have a reduced overall life expectancy, reduced quality of life and significant financial hardship. Poor patient outcomes primarily result from failings in perioperative care 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 affordable surgical treatment. As health systems work to increase the number of surgical procedures, we anticipate a further increase in complications and deaths after surgery. Without effective perioperative care, the positive impact of increasing provision of surgery will be limited, as will any net improvements in health for individuals and societies. We will establish sustainable research infrastructure in Africa and build on our world-leading applied research in a range of health-system contexts to develop effective solutions to this problem._x000D_ _x000D_ OBJECTIVES & METHODS_x000D_ Objective 1: Develop research leadership and capacity in four African nations_x000D_ Establish research hubs in four African universities with managerial, financial and governance infrastructure to become centres of research excellence, with a pan-African research design centre to lead international clinical trials. We will develop current and future research leaders and research professionals through training programmes, mentoring and PhD fellowships. Ultimately these hubs will become training centres for future African research professionals in our field._x000D_ _x000D_ Objective 2: Delivering research to improve outcomes after surgery across Africa_x000D_ Building on our successful international global health research, we will deliver a programme of observational studies of patient care, interviews with patients, staff and other stakeholders, large dataset research and large clinical trials across four key themes:_x000D_ 1) Developing realistic and sustainable models of Essential Critical Care_x000D_ 2) Improving identification of patients with life-threatening complications after surgery_x000D_ 3) Preventing and treating life-threatening bleeding after childbirth_x000D_ 4) Building linked national health data platforms (health registries) to assess the impact of Projects 1 to 3 and improve patient outcomes after surgery through international clinical audit and research_x000D_ _x000D_ Objective 3: Engage patients, communities and policy-makers_x000D_ Led by teams in Africa, we will establish meaningful community engagement at local, national and pan-African levels allowing us to work together to produce the research which is most relevant to patients. We will develop links with civil society, policy-makers and health professionals across partner nations and to ensure our research impacts patient care._x000D_ _x000D_ IMPACT_x000D_ Our research findings will inform changes in healthcare which could reduce deaths after surgery to the global average across Africa, saving 300,000 lives each year, improving long-term health and reducing financial hardship.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION;7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;GENERIC HEALTH RELEVANCE