“Improving Global Surgery Worldwide”

#1 “GlobalSurg-1 project; Determining universal markers of quality in abdominal surgery: an international prospective cohort study”

#2 Global PaedSurg-1 project: Ongoing for 2 years, Not published YET

#3 Global Neurosurg-1 project: Ongoing for 2 years, Not published YET

Dates of Projects’ Initiation and Completion: [January 2014] – [Ongoing]

Resulting Publications:

(1) GlobalSurg Collaborative: Mortality of emergency abdominal surgery in high-, middle- and low-income countries. British Journal of Surgery 05/2016; 103(8)., DOI: 10.1002/bjs.10151

(2) GlobalSurg Collaborative: Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries. British Medical Journal Global Health 12/2016; 1(4): e000091., DOI: 10.1136/bmjgh-2016-000091

(3) GlobalSurg Collaborative: Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection. BJS Open (2019).

(4) GlobalSurg Collaborative. Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study. Surg Endosc. April 2018. doi:10.1007/s00464-018-6064-9

(5) GlobalSurg Collaborative, Hannah S. Thomas, Thomas G. Weiser, Thomas M. Drake, Stephen R. Knight, Cameron Fairfield, Adesoji O. Ademuyiwa, … Ahmed Negida, et al. “Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy.” British Journal of Surgery 106, no. 2 (2019): e103-e112.

Funding Sources

GlobalSurg-1 study, Department for International Development–Medical Research Council–Welcome Trust Joint Global Health Trial Development grant (MR/N022114/1) and a National Institute of Health Research (NIHR) Global Health Research Unit Grant (NIHR 16/136/79).

Global PaedSurg-1 study: A grant from Welcome Trust Foundation to Dr. Naomi Wrights

Global Neurosurg-1 study: Self-funded, covered by Prof. Raslan and Dr. Negida

Technical Summary of Work

There are wide variations between world countries in the level of surgical care provided, operative management, and quality of surgery. These variations have an impact on patient outcome. The first project was the GlobalSurg-1 project run by the GlobalSurg Research Collaborative where we conducted an international prospective cohort study evaluating the management pattern and outcomes of emergency abdominal surgeries worldwide. By detecting the variations in practice between different countries, the project aims to understand the practices associated with best practice and best outcome (less mortality and less complications).

The project was delivered using social media to collaborating surgeons, trainees, and medical students worldwide. The project included 10,745 patients from 357 centers in 58 countries around the world. My role was the national research coordinator of Egypt; Egypt was one of the highest 3 participating countries in the world, providing data of 1,000 patients in this project and coordinating 27 hospitals in my country – Egypt.

The results showed that mortality rates of emergency abdominal surgery were 3 times higher in low- and middle- income countries compared with the high-income countries. The project also highlighted that surgical site infection was the major complication after surgery accounting for mortality of the patients. Multiple research papers were published from this project and it was the basis for subsequent similar collaborative studies in the field that are conducted until now.

Summary of the Significance of the Work

This project is important to my field because

There are wide variations in surgical practice between world countries. Patients in underserved areas and those in low-income countries have limited access to quality surgical care which lead to worse surgical outcome. This project highlighted the gap between the world countries in terms of the quality of surgical care and, it highlighted the risk factors related to high mortality rate. Surgical site infection was found associated with more death and complications following emergency abdominal surgeries, therefore, preventing the surgical site infection would contribute to decreasing the mortality. The project was the basis for many subsequent studies and improvements in surgical practice worldwide to decrease mortality and complications.

Summary of the Implementation/Influence of the Work

This work was heavily cited by several other research which a proof of its great impact and influence in the field.

[1] The findings of this project highlighted that surgical site infection was the commonest problem attributed to mortality after emergency abdominal surgery. As a result, another new worldwide project was started based on these findings to investigate surgical site infections.

[2] The society of University Surgeons Global Academic Surgery Committee published a guide to research in Academic Surgery, they cited our project as an example for innovative research design “one particularly innovative approach was demonstrated by the GlobalSurg Collaborative.15 The study utilized crowd-sourced, prospective, observational data to document postoperative mortality at 357 centers worldwide.”

Saluja, S., Nwomeh, B., Finlayson, S. R. G., Holterman, A. L., Jawa, R. S., Jayaraman, S., … Shrime, M. G. (2018). Guide to research in academic global surgery: A statement of the Society of University Surgeons Global Academic Surgery Committee. Surgery, 163(2), 463–466. doi:10.1016/j.surg.2017.10.013 

Major media coverage related to this research project

This publication got attention in 99% percentile; it is in the top 5% of the 13.5 million research papers that were ever tracked by Altimetric score (@Wiley Online Library)

[1] EL PAÍS

https://elpais.com/elpais/2018/05/15/planeta_futuro/1526390777_828242.html#?ref=rss&format=simple&link=link

[2] Edinburgh University Press

https://www.ed.ac.uk/news/2016/surgery-outcomes-suffer-in-poorer-countries

[3] Fox News

https://www.foxnews.com/health/death-after-surgery-three-times-more-likely-in-lower-income-countries

[4] DNS India (Diligint Media Corporation Ltd)

https://www.dnaindia.com/health/report-lower-income-country-patients-are-at-higher-risk-of-dying-new-study-2209324

[5] Beckers Hospital Review

https://www.beckershospitalreview.com/quality/patients-in-low-income-countries-have-greater-risk-of-dying-after-emergency-surgery.html

[6] China.org.cn

http://www.china.org.cn/world/Off_the_Wire/2016-05/05/content_38384612.htm

[7] Medical X Press

https://medicalxpress.com/news/2016-05-surgery-patients-income-countries-greater.html?src_id=alt

[8] In Mexican Media 

https://www.xeu.mx/nota.cfm?id=820987