Why Surgery Must Address Access, Equity, Diversity, and Sustainability: Insights from GlobalSurg Collaborative
The field of surgical research has experienced significant advances in the last three decades. Unfortunately, despite these improvements, the scope of surgical research has remained limited to comparing the benefits of one technique over another. As a result, new surgical devices or approaches may be poorly evaluated, leading to negative outcomes for patients.
The NIHR Global Health Research Unit for Global Surgery GlobalSurg Collaborative has identified three priority areas for surgery: access, equity, diversity, and sustainability. In this article, we explore each of these areas in-depth and consider why they are crucial for the future of surgery and patient care.
Access, Equity, and Public Health
The lack of access to safe and affordable surgical care is a significant global health issue, with five billion people unable to access these services in 2015. Of those who did have access, 33 million faced catastrophic healthcare costs paying for surgery and anesthesia. Furthermore, the COVID-19 pandemic has further exacerbated this issue, with over 28 million elective surgery cases being canceled worldwide.
Surgery plays a vital role in addressing some of the most critical global health challenges, including trauma, congenital anomalies, safe delivery, and non-communicable diseases. To improve access to surgical care, we need to recognize it as a crucial public health issue that must be given the same attention as other health services.
Inclusion and Diversity
The lack of inclusion and diversity in clinical practice and mainstream research has been a persistent issue in the surgical field. Women, minority groups, and patients from low- and middle-income countries remain underrepresented, leading to a research agenda that does not reflect the needs of all patients.
Advancing inclusion and diversity in surgical research will ensure that we generate pragmatic, simple, and context-specific research that addresses the needs of all patients. It is crucial to have a diverse range of perspectives in surgical research to conduct research with the greatest impact and move our field forward.
Climate Change and Sustainability
With the healthcare sector responsible for 4.4% of the world’s carbon emissions, reducing the environmental footprint of our practices is more critical than ever. Operating rooms are some of the areas of the hospital that consume the most energy and resources, and surgical practice relies heavily on single-use, non-biodegradable products. Anesthetic gases also contribute to the environmental footprint of surgery.
To address these environmental concerns, we must move towards sustainable surgical practices that reduce carbon emissions from the healthcare sector. By doing so, we can improve patient outcomes while also making surgical care more sustainable and better aligned with broader healthcare goals.
In Summary
To address the most pressing challenges faced by the surgical field, we must work to improve access, equity, diversity, and sustainability. These areas are interdependent and must be addressed simultaneously, requiring a cross-disciplinary approach to research and practice.
By embracing these priorities, we can position surgery as a leader in medical specialties and demonstrate its value as an essential element of universal healthcare. Not only will this improve patient outcomes, but it will also ensure that surgery is better positioned to address future challenges and remain at the forefront of the rapidly-evolving healthcare landscape.
Additional Insights
While the three priorities identified by the GlobalSurg Collaborative are crucial for the future of surgical research and practice, it is worth noting that there are other areas that must also be considered.
One such area is the importance of effective communication in surgical practice. Clear communication between members of the surgical team is vital to the success of any procedure, and miscommunications can have serious consequences for patient outcomes.
Another area that requires more attention is the use of technology in surgery. As technology continues to evolve, the surgical field must adapt to keep pace with these changes. From robotics to virtual reality, there are many technologies that could transform surgical practice and improve patient outcomes.
Finally, there is a growing need for more personalized surgical approaches that consider individual patient needs and circumstances. By taking a personalized approach to surgical care, we can ensure that patients receive the best possible outcomes while also minimizing the impact of surgery on their lives and their families.
Overall, the surgical field faces significant challenges, but there are also tremendous opportunities to improve patient outcomes and push the boundaries of what is possible in contemporary medical practice. By embracing the priorities identified by the GlobalSurg Collaborative and keeping an open mind about future developments and innovations, we can ensure that surgical care remains at the forefront of healthcare and continues to deliver value to patients and society as a whole.
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Despite the important advances of the last 30 years, surgical research is still limited to comparing the benefit of one technique over another. It can be based on assumptions that a new device or approach is always better, leading to poorly evaluated devices and procedures that have negative effects on patients.
writing on the lancetExperts from the NIHR Global Health Research Unit for Global Surgery GlobalSurg Collaborative, a program supported by funds from the NIHR (National Institute for Health and Care Research), propose three priority areas for surgery:
- Access, equity and public health must be recognized as crucial issues for surgery.
In 2015, five billion people did not have access to safe and affordable surgical care. Of those that did, 33 million people faced catastrophic health care costs paying for surgery and anesthesia. During the COVID-19 pandemic, more than 28 million elective surgery cases may have been cancelled. Surgery has a key role in addressing the most important and growing global health challenges, such as trauma, congenital anomalies, safe delivery and non-communicable diseases.
- Inclusion and diversity need to improve both in surgical research and in the profession.
Women, minority groups, and patients from low- and middle-income countries continue to be underrepresented in clinical practice and in mainstream research. Advancing inclusion and diversity will ensure a research agenda that offers pragmatic, simple, and context-specific research that reflects the needs of all patients.
- Climate change is the biggest global health threat facing the world.
Operating rooms are some of the areas of a hospital that consume the most energy and resources. Surgical practice relies on many single-use, non-biodegradable products, as well as anesthetic gases that have a large environmental footprint. Moving toward net-zero operating practices could reduce carbon emissions from the healthcare sector and allow surgeons and policymakers to reassess how surgery fits into the broader healthcare system.
Commentary 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. so.
“However, truly improving lives requires surgical researchers to use the next quarter century to address the most pressing questions of equity and access, the role of surgery in public health, and sustainability.
“Despite the problems of long waiting lists and the financial constraints of health systems, surgeons must focus on these priority areas: positioning surgery as a leader in medical specialties and demonstrating its value as a fundamental element of the universal health care.
Experts note that large randomized controlled trials with well-defined endpoints are now more common in surgical research, while exploration of the placebo effect has led to a fundamental reassessment of the benefits of some surgical procedures and whether they benefit patients throughout.
Surgeons and anesthetists have developed successful international collaborative research efforts that have enabled rapid recruitment of participants and globally relevant studies and trials, while following internationally established standards for clinical trial practice. Surgeons can now provide reliable answers to crucial questions in surgical surgery, and their research has improved patient care and the use of resources in healthcare systems.
https://www.sciencedaily.com/releases/2023/06/230606111731.htm
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