GlobalSurg Crowdsourcing: Innovation and collaboration to map surgery outcomes

Standing in a dark, windowless operating room in the Republic of Congo a few years ago when a power failure cut the lighting mid-surgery was a troubling reminder that many of the resources we take for granted at home are often a luxury for our colleagues working in low-resource settings. But what impact does this have on patient outcomes?

Surgery has long been a neglected component of global health systems. The gross inequity in access to safe, timely and affordable surgery and anaesthesia was brought sharply into focus by the recent Lancet Commission on Global Surgery. Unfortunately, despite this, a major barrier to understanding global surgery remains a lack of data from low and middle income countries, where virtually no outcome surveillance takes place.

The GlobalSurg Collaboration was founded in 2014 to address this, developing an innovative international network of front-line clinicians to collect clinical data. Building on the now well-established collaborative model, this novel method of professionally ‘crowdsourcing’ research was pioneered in the UK and Ireland through the STARSurg Collaborative as previously featured on this blog. This worldwide expansion allowed our methodology to be further developed for use across challenging global health settings.

The principle behind the GlobalSurg network is one of collaboration and capacity building. A high quality, peer reviewed study protocol is developed and disseminated globally through the internet, social media, professional networks, and mailing lists, often recruiting clinicians who have little opportunity to engage in local audit and research activities.

Collaborators complete online training, then collect prospective bedside-level clinical data over a short 2-week ‘snapshot’ period, designed to be deliverable in all settings. Data is then returned securely online for central validation and analysis, with many individual records collated into true ‘big data’ for global comparative analysis.

Uniquely, these results are stratified by the income and development levels of the participating centre’s country, allowing detailed global comparisons. Our findings are published using meritocratic group authorship (‘GlobalSurg Collaborative’) with all contributors listed as citable PubMed indexed collaborators.

The first GlobalSurg study investigated mortality in emergency abdominal surgery, selected as a key ‘bellwether’ procedure by the Lancet Global Commission, and a useful proxy for surgical care in general. Data were obtained for 10,745 patients from 357 centres in 58 countries by over 1,000 collaborators across high-, middle-, and low-income settings. This remarkable global collaboration established that mortality is three times higher in low- compared with high-income countries even when adjusted for prognostic factors. These landmark results were featured by Reuters and other news agencies around the world.

The second GlobalSurg study is currently live, and sets out to determine the worldwide epidemiology of surgical site infections after abdominal surgery. Currently over 2,000 collaborators in over 100 countries are registered to participate. Those wanting to learn more can download the protocol and register on our website and follow the latest updates on Twitter.

Importantly, the learning from this collaboration is two-way. An essential component of this network is promoting audit and research skills in areas where these are not commonly found. The GlobalSurg team have recently trialled the first international audit and research skills course in Rwanda, with further training trips already planned.

Looking to the future, this unique international network is rapidly becoming established as an efficient, effective and economical way to deliver large-scale, global ‘big data’ in near real-time. There is considerable scope for expanding this network further to address other clinical priorities, with plans to coordinate internationally relevant randomised trials in the near future.

This global, multi-centre collaboration has been a world-first. By inverting the traditional model of research, empowering front-line clinical staff, and breaking down international borders we hope the GlobalSurg network will make a significant contribution to defining future global health standards in surgery.

Follow Ed Fitzgerald, General Surgery Registrar, and Hon Clinical Advisor, Lifebox Foundation @DrEdFitzgerald.