Recently, 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. In an interview with Arab Health Magazine, Professor Dion Morton, Head of Academic Department of Surgery & Barling Professor of Surgery, University of Birmingham, discusses key outcomes from the event. Excerpts.
Could you please shed light on the surgical guidelines that were finalised in Dubai recently?
A two-phase Delphi exercise was undertaken with surgeons from 15 Low- and Middle-Income Countries (LMIC’s), including Mexico, India, South Africa, Ghana, Nigeria, Rwanda, Benin, Zambia, Philippines, and Pakistan. Questions were based on existing guidance and presented alongside the best evidence. Surgeons judged whether the interpretation of the evidence was appropriate/relevant to LMIC settings.
These 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 (SSI). The guidance will be published later this year in a leading medical research journal.
How was the response to the event? Why are these guidelines important?
The event followed a University of Birmingham-led conference in Kigali, Rwanda, in November last year, where experts came up with 31 evidence-based recommendations identified from existing High-Income Countries (HIC’s) SSI 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 recommendation was appropriate to their setting, current practice and whether implementation would be easy or difficult.
The surgeons felt that it was important to provide relevant guidance for LMIC surgeons, if the guidelines were going to be implemented effectively, which is why we hosted this event. At the Dubai conference, participants 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’.
Once published, these guidelines are set to help standardise and improve practice in surgery, and their value will be assessed thoroughly after publication and interpretation by a wider community.
What impact are these guidelines set to have in low- and middle-income countries?
SSI is the most common serious complication after surgery and is two times more common in LMIC countries than in HIC’s.
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 US$12.3 trillion in lost GDP by 2030.
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.
How can hospitals successfully implement these?
Along with our partners, we are currently establishing hubs and/or trial centres in partner countries that perform their own clinical research relevant to local populations, whilst serving global needs.
We 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 of the research as a tool to inform changes in clinical practise and provide evidence to drive policy changes across the globe.
If a specific community feels it is appropriate, we can undertake a prospective global audit of uptake to evaluate acceptability and impact.
Why, according to you, do surgical ethics matter?
Most surgical patients are extremely vulnerable and often anaesthetised. Ethical considerations are therefore paramount.