National priorities for perioperative research in South Africa

Abstract

Perioperative research is currently unco-ordinated in South Africa (SA). A large group of investigators and interested individuals collaborated under the auspices of the South African Perioperative Research Group (SAPORG), the members of which are listed in Appendix 1, to address this limitation. This initiative was undertaken because the group believed that: (i) collaborative research is necessary to address the clinical challenges encountered in perioperative care and outcomes, both in SA and globally; (ii) we have the capacity to conduct national and international collaborative research in SA; [1] (iii) collaborative research conserves the limited research resources in SA and globally; [2] (iv) there are urgent public health issues in perioperative medicine that need to be addressed to improve the health of the SA and/or global surgical populations; [1] and (v) a national research priority-setting process [3] is necessary to prioritise research in an environment of limited research resources. ObjectiveTo determine the top ten national research priorities for perioperative research in SA, using a national research prioritysetting process. MethodsA Delphi technique [4] was followed for this national research priority-setting project. It was conducted in four rounds. In the first round, an open email invitation was sent to approximately 600 individuals across SA, based predominantly on South African Surgical Outcomes Study (SASOS) participation [1] together with other perioperative and critical care research leaders who were identified to the group. Furthermore, the recipients were encouraged to forward the email to other individuals who might be interested in the research-setting process. In the first round respondents were asked to submit potential research questions or research priority areas. The responses were collated, and where appropriate research questions were amalgamated by BMB. This resulted in 116 potential research priority questions, covering a broad range of questions and including proposals within the following fields: national pragmatic trials, perioperative outcomes, cardiovascular, critical care, education, obstetrics, paediatrics, trauma and resuscitation, perioperative ultrasonography, burns and perioperative airway management.In the second round, these 116 potential research priority questions were circulated to all the respondents. They were asked to rank the top ten research questions, and where possible to provide justifications for inclusion or exclusion of priorities. In the third round, the same 116 questions were presented in rank order based on the responses from round two, with all submitted justifications attached. In this round the respondents were asked to consider re-ranking their previous submission from round two, based on the priorities ranking and justifications of the group. If the respondents preferred not to change their previous rankings, Background. Perioperative research is currently unco-ordinated in South Africa (SA), with no clear research agenda. Objective. To de...

Prioritizing research for patients requiring surgery in low- and middle-income countries

“…Rather than focusing on high‐resource procedures, the need for quality assurance of cancer surgery and short‐term outcomes was emphasized. A perioperative research prioritization exercise has been conducted previously in South Africa, although its results were country‐specific.…”

“…Previous research prioritization exercises have been limited to individual LMICs. To improve global provision for, and outcome from, surgically treated diseases, a structured process is required to select topics objectively for future large‐scale international research studies.…”

Can an Enhanced Recovery After Surgery (ERAS) programme improve colorectal cancer outcomes in South Africa?

“…SAPORG has this as one of its top ten perioperative research priorities. 19 However, implementation of ERAS in SA will require consideration of the very different health care context compared that of high income settings. Specifically, implementation will need to take into account the nutritional status of the population, the high prevalence of HIV, the limited access to health care and the resource-constrained health system.…”

Perioperative evaluation of patients who are due to undergo surgery

“…Members of SAPORG believe that: (i) colla bo rative research is necessary to address the clinical challenges encountered in perioperative care and outcomes, both in SA and globally; (ii) there is capacity to conduct national and international collaborative research in SA; (iii) collaborative research conserves limited research resources; (iv) there are urgent public health issues in perioperative medicine that need to be addressed to improve the health of the SA population; and (v) a national research priority setting process is necessary to prioritise research in an environment of limited research resources. [10] To this end, SAPORG has defined 10 research priorities for perioperative medicine in SA: (i) the establishment of a national data base of critical care outcomes and critical care resources; (ii) a randomised controlled trial of preoperative Btype natriuretic peptideguided medical therapy to decrease major adverse cardiac events after non cardiac surgery; (iii) a national prospective obser vational study of the outcomes associated with paediatric surgical cases; (iv) a national observational study of maternal and fetal outcomes following operative delivery in SA; (v) a steppedwedge trial of an enhanced recoveryaftersurgery programme; (vi) a steppedwedge trial of a surgical safety checklist of patient outcomes in SA; (vii) a prospective observational study of perioperative outcomes after surgery in district general hospitals in SA; (viii) shortcourse interventions to improve anaesthetic skills of rural doctors; (ix) studies of the efficacy of simulation training to improve patient outcomes, team dynamics and leadership; and (x) the development and validation of a risk stratification tool for SA surgery based on the SA Surgical Outcomes Study (SASOS) data. [10] A recent publication in the Lancet reported on a 7day, international, prospective, observational cohort study of patients aged ≥18 years undergoing any inpatient surgery in 25 countries in Africa (African Surgical Outcomes Study).…”

“…[10] To this end, SAPORG has defined 10 research priorities for perioperative medicine in SA: (i) the establishment of a national data base of critical care outcomes and critical care resources; (ii) a randomised controlled trial of preoperative Btype natriuretic peptideguided medical therapy to decrease major adverse cardiac events after non cardiac surgery; (iii) a national prospective obser vational study of the outcomes associated with paediatric surgical cases; (iv) a national observational study of maternal and fetal outcomes following operative delivery in SA; (v) a steppedwedge trial of an enhanced recoveryaftersurgery programme; (vi) a steppedwedge trial of a surgical safety checklist of patient outcomes in SA; (vii) a prospective observational study of perioperative outcomes after surgery in district general hospitals in SA; (viii) shortcourse interventions to improve anaesthetic skills of rural doctors; (ix) studies of the efficacy of simulation training to improve patient outcomes, team dynamics and leadership; and (x) the development and validation of a risk stratification tool for SA surgery based on the SA Surgical Outcomes Study (SASOS) data. [10] A recent publication in the Lancet reported on a 7day, international, prospective, observational cohort study of patients aged ≥18 years undergoing any inpatient surgery in 25 countries in Africa (African Surgical Outcomes Study). [11] A total of 11 422 patients were included from 247 hospitals serving a median population of 810 000, with a combined number of specialist surgeons, obstetricians and anaesthetists of 0.7/100 000 population.…”