The Operating Theatre Journal - Journal - Page 22
Surgeons must tackle three global
health challenges to save lives
Surgeons must look beyond the operating theatre to reduce major causes of death and improve access to surgical care.
Surgeons must look beyond the operating theatre and tackle three
major challenges with the most potential to reduce major causes of
death and improve access to surgical care, according to an international
group of experts.
Despite significant advances over the last 30 years, surgical research is
still limited to comparing the benefit of one technique over another. It
can be founded on assumptions that a new device or approach is always
better - leading to poorly evaluated devices and procedures having
negative effects on patients.
Writing in The Lancet, experts from the NIHR Global
Health Research Unit for Global Surgery GlobalSurg
Collaborative – a programme backed by funding from
the NIHR (National Institute for Health and Care
Research) – propose three priority areas for surgery:
• Access, equity, and public health must be recognised
as crucial issues for surgery.
In 2015, five billion people did not have access to safe and
affordable surgical care [1]. Of those who did, 33 million individuals
faced catastrophic health expenditure in payment for surgery and
anaesthesia. During the COVID-19 pandemic, over 28 million cases
of elective surgery are likely to have been cancelled. Surgery has a
key role in addressing the most important and growing global health
challenges, such as trauma, congenital anomalies, safe childbirth,
and non-communicable diseases.
[1] The Lancet Commission on Global Surgery 2030
• Inclusion and diversity must improve in both surgical
research and the profession.
Women, minoritised groups, and patients from low-income and
middle-income countries remain under-represented in clinical
practice and major research work. Advancing inclusion and diversity
will ensure a research agenda that delivers pragmatic, simple, and
context-specific research that reflects the needs of all patients.
Surgeons must look beyond surgery to save lives
Surgeons and anaesthetists have developed successful international
collaborative research efforts that have enabled rapid recruitment of
participants and globally relevant studies and trials, while following
internationally set standards of clinical trial practice. Surgeons can now
provide reliable answers to crucial questions in operative surgery, and
their research has improved patient care and resource use in health
systems.
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• Climate change is the greatest global health threat
facing the world.
Surgical theatres are some of the most energy and resource intense
areas of a hospital. Surgical practice relies on many single-use, nonbiodegradable products as well as anaesthetic gases that have a
large environmental footprint. Moving towards net-zero operating
practices could reduce health-sector carbon emissions and allow
surgeons and policy makers to reassess how surgery fits into a wider
health system.
Comment co-author Dmitri Nepogodiev, from the University of
Birmingham, said: “Richard Horton, Editor-in-Chief of The Lancet, once
described surgical research as ‘a comic opera performance’. That was
in 1996 and things have changed significantly since then.
“Truly improving lives requires surgical researchers to use the
next quarter of a century to tackle the most pressing questions
on equity and access, the role of surgery in public health, and
sustainability.”
Dmitri Nepogodiev - University of Birmingham
“However, truly improving lives requires surgical researchers to use the
next quarter of a century to tackle the most pressing questions on equity
and access, the role of surgery in public health, and sustainability.
“Despite the problems of large waiting lists and an economic squeeze
on health systems, surgeons must focus on these priority areas - placing
surgery as a leader in medical specialties and demonstrating its value
as a fundamental element of universal health care.”
The experts note that large, randomised controlled trials with welldefined endpoints are now more usual in surgical research, whilst
exploration into the placebo effect, has led to a fundamental reexamination of the benefits of some surgical procedures and whether
they benefit patients at all.
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