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’s global health research unit for global surgery (the GlobalSurg collaborative) – a programme backed by funding from the National Institute for Health and Care Research – propose three priority areas for surgery:
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.
“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 well-defined endpoints are now more usual in surgical research, while exploration into the placebo effect, has led to a fundamental re-examination of the benefits of some surgical procedures and whether they benefit patients at all.
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.