GlobalSurg global surgery research collaboration - GASOC presentation in Oxford

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GlobalSurg was established to represent practising surgeons from around the world and support collaborative international research into surgical outcomes by fostering local, national and international research networks. Our growing network now includes over 5000 clinicians in more than 100 countries. The ethos is inclusive and collaborative: our international cohort studies are open to all collaborators, including medical students, clinical officers, doctors, nurses and researchers. We run annual research prioritisation events, allowing surgeons from all over world to contribute to the direction of the group. Our cohort studies aim to give grass-root surgeons the opportunity to participate in major projects. They are designed to ensure easy delivery by local surgeons and will not require extra resources or funding. Every researcher who contributes data into a cohort study is a Pubmed-citable collaborator on study papers which will be published under one main name – GlobalSurg – to represent our group effort.

Healthcare

Evidence-Based Global Surgery
www.GlobalSurg.org
Dr Edward Fitzgerald
@DrEdFitzgerald

What is GlobalSurg?
Meritocratic group authorship Building global networks
Snap-shot methodology
Align projects to clinical needs Any hospital, any where
High-quality, protocol-led Empowering grass-roots surgeons
Building research capacity
Prospective, bedside-level patient data
Perioperative outcomes by HDI

A new way of doing research
EFFICIENT
EFFECTIVE
ECONOMICAL
Protocol-led, core data set, snap-shot methodology
Global penetrance, rapid completion and turn-around
Minimal financial support, own time, low burden

How is it delivered?
Peer reviewed
protocol
disseminated
globally
Collaborator
registration
online
Country leads
coordinate
Complete online
training module
Online central
support and
troubleshooting
14-day snapshot
data collection
within 6-month
window for
participation
Online data
upload and
central analysis

Global ‘Crowd-sourced’ Surgical Outcomes
www.globalsurg.org

HIGH HDI MIDDLE HDI LOW HDI
6538 patients
(60.8%)
2889 patients
(26.9%)
1318 patients
(12.3%)
10,745 patients357 hospitals 58 countries
Primary Outcome: 24-hour postoperative mortality rate (POMR)
Secondary Outcome: 30-day postoperative mortality rate (POMR)
HDI = Human Development Index

Mortality is three times higher in low- compared with high-HDI
countries even when adjusted for prognostic factors
Collaboration Driven High-Impact Results
GlobalSurg Collaborative. BJS 2016; 103: 971–988

Open publication of peer reviews
http://globalsurg.org/read-the-peer-reviews-for-globalsurg-1/

Adjusted mortality in children up to 7 times greater in low-HDI and
middle-HDI countries compared with high-HDI

GlobalSurg 2
Determining the worldwide epidemiology of surgical site
infections after abdominal surgery
www.globalsurg.org │ enquiry@globalsurg.org

Establishing a robust validation process
1. Centre-based collaborator questionnaire
2. Independent on-site validation
• Case ascertainment
• Sampled data accuracy
3. Collaborator interview (process vs. system)

1. LMICs more likely to use postop antibiotics
2. Antibiotic course likely to be longer
3. Organisms twice as likely to be resistant in LIMCs
Between 1-in-5 and 1-in-3 infections are resistant to the antibiotic prescribed

GlobalSurg 3
www.globalsurg.org │ enquiry@globalsurg.org

GlobalSurg 3: Your opportunity
Determine variation in quality of cancer surgery worldwide
• Breast, gastric & colon cancer
• Any hospital, any where
• 4-week periods between April 1st & October 31st 2018
Quality measures include
• Infrastructure
• Care processes
• Outcomes
Primary outcome measure
• 30-day mortality/complication rates

Collaboration: Future vision
• Large-scale collaboration normalised
• Methods adopted globally for other clinical areas
• Incorporated into training programmes
• Hands-on research skills training
• All allied-health professional contributing
• Role for all in participating and up-skilling
• Results used as foundation for interventions
• Technology and live data/analysis evolves

https://www.youtube.com/watch?v=STnx6VliTIQ

• Website: www.globalsurg.org
• Email: enquiry@globalsurg.org
www.facebook.com/GlobalSurg
@GlobalSurg
• GlobalSurg is run by the SURG Foundation charity.
• Please donate to support us! https://www.givey.com/surg_foundation
Thank you

Please make a donation to support!
https://mydonate.bt.com/fundraisers/kiliforlifebox#donationSummary
Fundraising for the Lifebox Foundation
We’ve climbed Mount Kilimanjaro to raise funds for Lifebox!
5895 metres

The document discusses COSECSA's efforts to address the shortage of surgeons in East, Central and Southern Africa. It notes that over 5 billion people lack access to safe and affordable surgery. COSECSA has worked to enhance surgical training programs, increase the number of examinations, and build infrastructure like the East and Central African Journal of Surgery. Through partnerships with organizations like RCSI, it has helped train over 1,600 surgeons who have an 84% retention rate in Africa. COSECSA aims to continue developing sustainable indigenous training initiatives to address the large unmet need for surgical services in the region.

Ureteric injuries in gynecological surgeries

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Urinary tract injury during female pelvic surgery occurs in 0.3-1% of procedures but can be as high as 2.4%. Risk factors include prior pelvic surgery, endometriosis, and pelvic masses. The ureters pass through the pelvis and can be injured at various points, most commonly when ligating the ovarian or uterine vessels. Identifying and isolating the ureters and bladder during surgery is important to prevent injury from other surgical maneuvers.

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This document discusses the surgical principles of gynecologic oncology. It covers topics such as the anatomy of the female pelvis and lymphatic drainage, different surgical incisions and techniques, lymph node dissection, radical hysterectomy classification, cancer debulking, urinary diversion procedures, and the surgical management of specific gynecologic cancers including vulvar carcinoma, vaginal carcinoma, and cervical carcinoma. The future of gynecologic oncology with a focus on early diagnosis, prevention and minimally invasive surgery is also mentioned.

Surgical site infection - Recent Guidelines

Dr Meenakshi Sharma

The document provides guidelines from various global and national organizations on preventing surgical site infections (SSIs). It discusses: - Proper preoperative patient preparation including bathing with chlorhexidine soap, hair removal only with clippers, and use of oral antibiotics with bowel preparation for colorectal surgery. - Optimal intraoperative practices like alcohol-based antiseptic skin preparation, intensive blood glucose control, and appropriate timing of prophylactic antibiotics. - Postoperative wound management including aseptic dressing changes, saline cleansing, and avoiding use of topical antimicrobial agents on primarily closed wounds.

urethrovaginal fistula

Ahmed Eliwa

Urethrovaginal fistulae most commonly occur as a result of vaginal surgery such as anti-incontinence surgery or prolapse repair. Other causes include radiation therapy, trauma, and vaginal neoplasms. Symptoms depend on fistula size and location, with proximal fistulae possibly causing stress incontinence or continuous incontinence. Repair of urethrovaginal fistulae is more challenging than vesicovaginal fistula repair due to soft tissue defects and lack of viable tissue. Adjuvant procedures like Martius flaps are often used to aid repair. Success rates are variable but generally not as high as for vesicovaginal fistula repair, and multiple

Ureteric injury in Gyenec Surgery

Jograjiya Gelabhai Raghubhai

This document discusses ureteric injury as a complication of gynecologic surgery. It covers the incidence, risk factors, applied anatomy of the pelvic ureter, common sites of injury, prevention strategies, and management approaches. Ureteric injury can occur in 0.03-6% of hysterectomies, with laparoscopic hysterectomy having the highest risk. The pelvic ureter has variable anatomy and is susceptible to injury at sites like the pelvic brim. Prevention focuses on proper identification and dissection of the ureter during surgery. Management depends on the severity and timing of injury but may involve stenting, urinary diversion, or ureteral reimplantation

Damage control surgery

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Damage control surgery (DCS) is an approach used for severely injured trauma patients that focuses on rapidly addressing life-threatening issues like hemorrhage rather than fully repairing anatomy. It aims to prevent the lethal triad of hypothermia, acidosis, and coagulopathy that can result from long operations and blood loss. Key aspects of DCS include temporary measures like packing bleeding liver injuries; stapling but not repairing some intestinal injuries; leaving unrepaired vascular injuries clamped; and rapidly closing the abdomen with clips rather than drains to allow reoperation once the patient is stabilized. The goal is definitive repair within 24 hours once the patient's physiology is corrected.

Bowel anastomosis

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This document discusses various techniques for performing anastomoses during gastrointestinal surgery. It notes important factors to consider like blood supply, tension, and diameter. For colorectal and small bowel anastomoses, it recommends using slowly absorbable monofilament sutures with a 5mm bite from the margin. A single-layer inverting anastomosis is preferred for colorectal procedures as it is less time-consuming and reduces inflammation. Advantages of the single-row suture technique include faster performance and less trauma. End-to-end anastomoses should include the muscular mucosa. Side-to-side anastomoses employ a four-layer technique with separate sutures for the posterior

Hysterectomy is a common surgery but has risks and downsides. There are often alternatives to removing the uterus that can treat conditions like fibroids without surgery. Non-surgical options include medications, uterine artery embolization, MRI-guided focused ultrasound, and other procedures to destroy or remove fibroids. While hysterectomy may be necessary in some cases, it should not be the default option and removing just the disease rather than the whole organ is preferable when possible.

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- Anastomotic leakage is a dangerous surgical complication that increases mortality and morbidity. It occurs when there is a defect in the intestinal wall at the site of bowel reconnection that allows internal and external bowel contents to mix. - Risk factors include patient characteristics like age and comorbidities, neoadjuvant treatments, surgical factors like emergency surgery or surgeon experience, and technical aspects of the anastomosis. - Preventive measures include temporary stomas, but leakage risk can't be eliminated. Early detection through close postoperative monitoring and imaging is important, as early treatment improves outcomes. Treatment depends on the severity but may include drainage, resection and reanastomosis or stoma formation.

Ureteric injuries

arul velusamy

This document discusses the anatomy, causes, diagnosis, and management of ureteric injuries. The key points are: 1. The ureters have a close anatomical relationship with major vessels that can lead to injuries during surgery or trauma. 2. Ureteric injuries can occur during open or laparoscopic abdominal/pelvic surgeries, endoscopic procedures, or external trauma. 3. Diagnosis may be intraoperative or delayed, detected by imaging showing extravasation or hydronephrosis. 4. Management depends on the location and severity of injury, and may include ureteroureterostomy, transureteroureterostomy,

Dr rabi postpartum contraception

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Contraception in the postpartum period differs due to breastfeeding, increased risk of blood clots, and unpredictable ovulation. Counseling should occur during antenatal and postnatal periods. Options include breastfeeding, progestin-only pills, implants, IUDs, sterilization, condoms. Timing of use depends on breastfeeding status and bleeding risk. Recommendations balance effectiveness, safety, and ease of use while supporting breastfeeding.

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This document discusses techniques for preventing adhesions in gynecological surgeries. It covers the pathophysiology and risk factors for adhesion formation. Good surgical techniques like minimizing tissue trauma and drying can help reduce adhesions. Laparoscopy is associated with fewer adhesions than laparotomy due to less tissue handling and drying. Various barrier agents are described but have limitations. Current research focuses on hydrogels and other absorbable barriers that are easy to apply and prevent reformation of adhesions. Further studies are still needed to determine the best strategies and agents for adhesion prevention.

Hysteroscopic endometial resection

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This document discusses endometrial ablation, which is a treatment for abnormal uterine bleeding where the endometrium is destroyed. It notes that endometrial ablation has advantages over hysterectomy as it is less invasive, allows the uterus to be preserved, and has a shorter recovery time. The document provides details on the various techniques for endometrial ablation and notes it is most effective when performed hysteroscopically to allow direct visualization. Preparation of the endometrium and cervix is recommended to improve outcomes.

Urinary Incontinence Surgery

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This document discusses ureteric injuries that can occur during hysterectomy and how they are detected and treated. It notes that the overall incidence of ureteric injury during hysterectomy is 0.4% and risk factors include previous surgery, endometriosis, and dense adhesions. Common sites of injury are where the ureter crosses the uterine artery and in the tunnel of Wertheim. Injuries can be detected by checking for urine efflux during cystoscopy and using retrograde pyelography to visualize the ureters with dye. Prevention involves thorough knowledge of pelvic anatomy, ligation techniques to avoid the ureters, and identifying the ureters before ligating other structures in complex

Step wise pelvic devascularisation

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Shirodkar sling surgery

Niranjan Chavan

1. Shirodkar's sling surgery is a conservative surgical procedure for uterine prolapse that involves attaching a tape to the cervix and passing it through the broad ligaments and behind the sigmoid colon to attach to the sacral promontory, creating a hammock of support. 2. It was developed by Dr. V.N. Shirodkar in the 1960s as one of several sling procedures established in India to address high rates of uterine prolapse among young, anemic women after childbirth. 3. The procedure involves making an abdominal incision, attaching a tape to the cervix, passing it through the broad ligaments and retroperitoneum on each side

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Sujoy Dasgupta

1. Ulipristal acetate is a selective progesterone receptor modulator approved for treatment of uterine fibroids. It binds to progesterone receptors and blocks their action, reducing fibroid size and symptoms without affecting estrogen levels. 2. Studies showed ulipristal acetate effectively controlled bleeding and reduced fibroid volumes more rapidly than leuprolide acetate. It maintained fertility without significant safety issues. 3. Long term treatment with ulipristal acetate provided sustained control of bleeding and pain, with shrinkage of fibroid volumes maintained during off treatment periods. Quality of life was improved.

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This document discusses laparoscopic assisted vaginal hysterectomy (LAVH). It begins with a brief history of laparoscopic hysterectomy and incidence rates of different hysterectomy methods from various studies. It then describes the classification, indications, procedure, complications, and comparison of LAVH, vaginal hysterectomy, and abdominal hysterectomy. While laparoscopic hysterectomy may be preferred for its minimal invasiveness, the document emphasizes that vaginal hysterectomy should be performed when possible to avoid unnecessary procedures. In conclusion, it states that the main goal of LAVH is to reduce abdominal hysterectomy rates by utilizing it where vaginal hysterectomy is contraindicated.

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This document discusses appendicitis during pregnancy. It covers the epidemiology, anatomical changes, pathophysiology, complications, diagnosis, differential diagnosis, and surgery of appendicitis in pregnant patients. The key points are that appendicitis occurs in about 1 in 1500 pregnancies, symptoms can be more difficult to diagnose due to pregnancy-related changes, ultrasound and CT scan are used for diagnosis but have limitations during late pregnancy, and prompt surgical treatment is indicated to prevent complications of perforation for both the mother and fetus.

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STARSurg is a student-led collaborative that empowers medical students to participate in national research studies related to surgery. It facilitates annual research projects involving over 1000 collaborators across multiple medical schools. Participating students gain transferable skills in research, audit, and evidence-based practice while making meaningful contributions through studies published in top journals. STARSurg aims to promote a culture of student engagement in research through training, online resources, and recognition of student work.

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This document discusses how social media can be used to connect surgical trainees, promote peer support and education, engage in medico-political issues, and stay updated on society and organizational matters. It provides examples of hashtags and Twitter handles related to surgery. Social media also enables collaboration on audit and research projects, including a global study on surgical outcomes from over 10,000 patients at 357 hospitals in 58 countries. The study found mortality was three times higher in low human development index countries. Overall, the document advocates for the use of social media in surgery to facilitate international collaboration and high impact studies.

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1. Evidence-Based Global Surgery www.GlobalSurg.org Dr Edward Fitzgerald @DrEdFitzgerald

3. What is GlobalSurg? Meritocratic group authorship Building global networks Snap-shot methodology Align projects to clinical needs Any hospital, any where High-quality, protocol-led Empowering grass-roots surgeons Building research capacity Prospective, bedside-level patient data Perioperative outcomes by HDI

4. A new way of doing research EFFICIENT EFFECTIVE ECONOMICAL Protocol-led, core data set, snap-shot methodology Global penetrance, rapid completion and turn-around Minimal financial support, own time, low burden

6. How is it delivered? Peer reviewed protocol disseminated globally Collaborator registration online Country leads coordinate Complete online training module Online central support and troubleshooting 14-day snapshot data collection within 6-month window for participation Online data upload and central analysis

9. Global ‘Crowd-sourced’ Surgical Outcomes www.globalsurg.org

10. HIGH HDI MIDDLE HDI LOW HDI 6538 patients (60.8%) 2889 patients (26.9%) 1318 patients (12.3%) 10,745 patients357 hospitals 58 countries Primary Outcome: 24-hour postoperative mortality rate (POMR) Secondary Outcome: 30-day postoperative mortality rate (POMR) HDI = Human Development Index

11. Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors Collaboration Driven High-Impact Results GlobalSurg Collaborative. BJS 2016; 103: 971–988

12.

13.

14. www.globalsurg.org

15.

16. Global feedback in real time

17. v

18. Open publication of peer reviews http://globalsurg.org/read-the-peer-reviews-for-globalsurg-1/

19. Adjusted mortality in children up to 7 times greater in low-HDI and middle-HDI countries compared with high-HDI

20. GlobalSurg 2 Determining the worldwide epidemiology of surgical site infections after abdominal surgery www.globalsurg.org │ enquiry@globalsurg.org

21. Establishing a robust validation process 1. Centre-based collaborator questionnaire 2. Independent on-site validation • Case ascertainment • Sampled data accuracy 3. Collaborator interview (process vs. system)

22. GlobalSurg 2

23.

24. 1. LMICs more likely to use postop antibiotics 2. Antibiotic course likely to be longer 3. Organisms twice as likely to be resistant in LIMCs Between 1-in-5 and 1-in-3 infections are resistant to the antibiotic prescribed

25.

26. Significant Global Impact

27. GlobalSurg Combined

28. GlobalSurg Combined

29. GlobalSurg 3 www.globalsurg.org │ enquiry@globalsurg.org

30. GlobalSurg 3: Your opportunity Determine variation in quality of cancer surgery worldwide • Breast, gastric & colon cancer • Any hospital, any where • 4-week periods between April 1st & October 31st 2018 Quality measures include • Infrastructure • Care processes • Outcomes Primary outcome measure • 30-day mortality/complication rates

31.

32. Collaboration: Future vision • Large-scale collaboration normalised • Methods adopted globally for other clinical areas • Incorporated into training programmes • Hands-on research skills training • All allied-health professional contributing • Role for all in participating and up-skilling • Results used as foundation for interventions • Technology and live data/analysis evolves

33. https://www.youtube.com/watch?v=STnx6VliTIQ

34. • Website: www.globalsurg.org • Email: enquiry@globalsurg.org www.facebook.com/GlobalSurg @GlobalSurg • GlobalSurg is run by the SURG Foundation charity. • Please donate to support us! https://www.givey.com/surg_foundation Thank you

35. Please make a donation to support! https://mydonate.bt.com/fundraisers/kiliforlifebox#donationSummary Fundraising for the Lifebox Foundation We’ve climbed Mount Kilimanjaro to raise funds for Lifebox! 5895 metres

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