Major clinical trial aims to combat post-surgical health inequalities

A team of clinicians and researchers at UCLH and UCL have been awarded a £2.8 million grant to combat health inequalities in patients having major surgery. 

The grant from the National Institute for Health and Care Research (NIHR) will see dozens of NHS clinicians and university researchers attempting to recruit about 2,600 patients into this large-scale study known as Hippocrates, which hopes to find ways of improving outcomes for poorer people after surgery. 

“We already know that people experiencing deprivation tend to live shorter lives and suffer from worse health,” Professor Ramani Moonesinghe, the study’s chief investigator said. 

“Our previous research found that people living in more deprived areas are more likely to suffer from complications or die after major surgery, despite receiving hospital care which is just as good as that provided to others,” she said. Professor Moonesinghe is a UCLH consultant in anaesthesia and perioperative medicine and a UCL professor of perioperative medicine. She is also the National Clinical Director for Critical and Perioperative Care at NHS England. 

She added: “We have grown tired of waiting for broader societal changes to impact on these health inequalities – therefore our research will engage people from poorer communities to help us design ways to improve their surgical outcome and overall health. We will then test these interventions in a randomised controlled trial across some 40 NHS hospitals.” 

The six-year study will be a focal point for three UCL PhD students who will be embedded within the study team. They are UCLH resident doctor in anaesthesia Adam Hunt, health psychologist Katie Gilchrist and health services researcher Sigrún Clark. 

The team has identified three themes to focus on: helping patients get healthier before they undergo surgery, improving the way patients are monitored after surgery and providing financial help before and/or after surgery. The study team will work with experts as well as people who have experienced social or economic deprivation to design the interventions. 

Mrs Gilchrist is the study lead for patient and public involvement (PPI). Explaining the research design she said: “We know it is important to tailor the design to the needs and preferences of those we will eventually support with these interventions. Patients will be more likely to accept these interventions if they have had the opportunity to influence the decisions. 

“We will be inviting around 100 patients and members of the public to help us design the interventions we are looking to evaluate, as well as our core PPI group who will guide the design and delivery of the whole research project throughout the six years. Over and above the actual interventions, we will also learn a lot about co-design with patients and public, and how to recruit and engage people from more marginalised communities.” 

The interventions will be tested on some 420 patients in a pilot ‘platform’ clinical trial run by the UCL Comprehensive Clinical Trials Unit (CTU). The pilot will evaluate the effectiveness, cost and compliance of each intervention and then select one or more for a full randomised controlled trial in at least 2600 patients.  

“The full trial should give us a definitive answer about whether the interventions improve postoperative outcome – specifically, death and complications after surgery. What we learn should also have implications for how we can reduce health inequalities in other areas of healthcare, in keeping with one of the key priorities of the NHS 10-year plan,” Professor Moonesinghe said.