Perioperative Medicine

Director: Prof. Ramani Moonesinghe

Deputy Directors: Professor Cecilia Vindrola-Padros and Dr Steve Harris

Programme Manager: Dr Laura Saucedo-Cuevas

The CL-PSRC is an NIHR-funded infrastructure programme, established in April 2023. Six PSRCs have been funded in England, tasked with improving patient safety through research, innovation and collaboration. 

The CL-PSRC’s mission is to improve the health and wealth of the nation, and to reduce health inequalities, primarily through research aimed at reducing harm in SPACE specialities (Surgical, Perioperative, Acute, and Critical carE), which can be translated to other clinical services. 

The PSRC supports over 25 individual research projects, a flourishing career development academy and is founded on a strong partnership with patients and the public. Further information can be found on our dedicated website.

Leads: Professor Ramani Moonesinghe and Dr David Brealey

Programme Manager: Dr Louise English

The UCLH NIHR Biomedical Research Centre (BRC) is funded through the NIHR’s BRC scheme and is in its 4th 5-year funding cycle. This is the first cycle in which we have had a critical and perioperative care theme, and we are one of only two in the country (the other at Southampton, with which we collaborate closely). BRCs focus on experimental medicine and discovery science, including first-in-human research. Our theme has a diverse portfolio which includes data science, drug and device development, and collaborations with basic scientists, clinicians and industry.

The CPC BRC theme supports multiple experimental and early translational research projects – more information can be found on our dedicated website.

Director: Prof. David Walker

Deputy Director: Ms Carolina Britton

Strategic Partner: Mr Oscar Fernandez, UCLH

POWER is an education partnership between our UCL centre and the Division of Surgery and Anaesthesia, University College Hospital.  Our aim is to develop opportunities to support the recruitment, retention and professional development of perioperative teams.  We work collaboratively with NHS England and hospital trusts to develop engaging educational material to poly-skill our workforce.   

Director: Prof. Ramani Moonesinghe

Established in 2000, we use measurement to improve the quality of perioperative healthcare. Our work focuses on:

• Risk prediction: Understanding and improving methods to predict adverse outcomes (complications and mortality) after major non-cardiac surgery.
• Innovation in measurement: Development and validation of measures for assessing outcome from major surgery: encompassing complications and patient-reported outcome
• Improvement Studies: using measurement to improve quality of care; dissemination of learning for quality improvement.
• Clinical Trials: Phase 2 and 3 trials evaluating novel interventions, including devices and pathways

Key Current Projects

PQIP: The Perioperative Quality Improvement Programme evaluates the care and outcomes of patients undergoing major surgery in the UK. Over 60,000 participants recruited so far (Jan 2025), making it the largest research study of its kind in the NHS. 

SONAR1 – The first Snapshot Obstetric National Anaesthesia Research project started in February 2025 and evaluate the incidence, risk factors for and outcomes of pain experienced by women giving birth by Caesarean section under regional anaesthesia (i.e. awake but with their abdomen numbed). Over 100 NHS sites will take part in this study: for more information, see our dedicated website.

The Little Journey Trial – This NIHR-funded Phase III research study recruited patients between 2019 and 2024. It evaluated a novel virtual reality preparation app – the first of its kind – to see if it would reduce anxiety in children between the age of 3 and 12 having day-case surgery and their first general anaesthetic. 594 children were recruited and the results will be published in 2025. 

CASAP: Children’s Acute Surgical Abdomen Programme: a collaboration with the Royal College of Anaesthetists and the Association for Paediatric Anaesthetists, we studied over 3000 children undergoing emergency abdominal surgery. 

HIPPOCRATES: Health Inequalities in PerioPerative Outcomes – CreATing and Evaluating targeted Support interventions. This is an NIHR Programme Grant which started in April 2025. HIPPOCRATES will develop treatments ('interventions') aimed at reducing harm associated with surgery in patients from poorer (hereafter referred to as deprived) backgrounds. We will then study if, and how, these interventions work. The programme will take 6 years and includes epidemiological analysis of large datasets, co-design with patients and public from deprived backgrounds, and a randomised controlled trial. Further information will be available from our website in due course.

Director: Dr John Whittle

Our research focuses on the relationship between preoperative physiology and outcomes after major surgery.  We aim to uncover underlying mechanisms that drive the development of postoperative complications.

We work closely with our colleagues in surgery, anaesthetics and critical care at University College London Hospitals and beyond to examine interventions that might improve outcomes after major surgery.  HPPL conducts research that crosses the translational divide between basic science and clinical implementation.  We have established collaborations within UCL with the Bloomsbury Institute of Intensive Care Medicine, the CPOM Surgical Outcomes Research Centre (SOuRCe), CHIMERA (Collaborative Healthcare Innovation through Mathematics, Engineering and AI) and the Hawkes Institute. We also have several international collaborations with specialist metabolic and mitochondrial laboratories and with Industry partners in relevant fields. 

Key Projects

Our current program of work is divided into four core inter-related streams. 

1. Our flagship study is POM-MP (Perioperative Medicine-Metabolic Profiling), which aims to unpick some of the established relationships between physical fitness and outcomes after surgery.  We are examining how fitness assessed through formal exercise testing and fuel (sugars, proteins and fats) usage relates to the development of medical complications after surgery.  In parallel, we are assessing how body composition and immune function relate to fitness and the subsequent development of infections in surgical patients.
2. In addition, we collect an ongoing database of clinical exercise tests (CPET) that we use as the backbone of our work.  We link these data with clinical outcomes after surgery and use it to help design and assess novel interventions to improve postoperative outcomes, including prehabilitation and nutritional interventions such as protein supplementation.
3. Data from our studies and databases are used to develop and assess novel machine learning techniques to support clinical risk prediction and to understand the complex relationships between physiological and medical variables and how they interact with surgical outcomes.
4. Finally, we run a clinical prehabilitation (preventative rehabilitation) and optimisation program at University College London Hospitals for the direct benefit of patients.  This program also offers the opportunity to assess the impact of targeted interventions on surgical outcomes and acts as a platform for translational clinical studies. 

Director: Professor Cecilia Vindrola

RREAL is a multidisciplinary team combining expertise in medical anthropology, psychology, medical sociology, digital sociology and social epidemiology. The aim of RREAL is to improve the quality and impact of rapid research used to study and evaluate clinical and health service models and interventions for time-sensitive contexts. 

Current workstreams include:

• Health services research and implementation research in the NHS
• Methodological innovation
• Global health
• Clinical trials
• Rapid reviews

Projects

1. PSRC: RREAL is a partner in the Central London Patient Safety Research Collaborative (PSRC), funded by NIHR. Prof Vindrola leads Theme 2 on organisational learning and contributes to Theme 1 on safer services.
2. Generation study: RREAL leads the process evaluation for the Generation Study to evaluate the implementation of genomic newborn screening in the NHS, funded by Genomics England.
3. AIR SAFETY: RREAL is a partner in AIR SAFETY: A programme to prevent aerosol borne respiratory diseases using Artificial Intelligence, funded by NIHR.
4. POPS-SUP: RREAL is a partner in POPS-SUP: Implementation of Comprehensive Geriatric Assessment based perioperative medicine services to improve clinical outcomes for older patients undergoing elective and emergency surgery with cost effectiveness, funded by NIHR.
5. BRIGHTLIGHT 2021: RREAL is responsible for a rapid ethnography for the project BRIGHTLIGHT 2021: What clinical outcomes are associated with the ‘joint care’ for teenagers and young adults with cancer?, funded by NIHR.
6. STREAM: RREAL are working to improve the transparency and completeness of reporting and to increase the quality of rapid studies by developing Standards for Rapid Evaluation and Appraisal Methods (STREAM), funded by MRC-UKRI.
7. LISTEN: RREAL has developed the Collaborative and Digital Analysis of Big Qual Data in Time Sensitive Contexts (LISTEN) method, funded by MRC-UKRI.
8. Understanding and unpacking debates in mental health: This project identified key debates hindering the progress of mental health science, providing context on their relevance and stakeholders involved. Funded by the Wellcome Trust.
9. Digital mental health landscaping in low- and middle-income countries: This project mapped the digital mental health landscape, identifying key players, activities, and locations. Funded by the Wellcome Trust.
10. Clinical trials: RREAL leads on the qualitative research components for the following clinical trials:
    1. Role of ward-based goal-directed fluid therapy (GDFT) in acute pancreatitis: A feasibility randomised controlled trial.
    2. Anaesthesia Choice for Creation of Arteriovenous Fistulae (ACCESS study).
    3. Volatile vs Total intravenous Anaesthesia for major non-cardiac surgery - A pragmatic randomised controlled trial.
    4. WAFER trial: a feasibility randomised controlled trial comparing wide-awake local anaesthesia no tourniquet (WALANT) to general and regional anaesthesia with tourniquet for flexor tendon repair.
    5. MULTI-centre feasibility study to assess the use of 99mTc-sestaMIBI SPECT/CT in the diagnosis of kidney tumours (MULTI-MIBI study).

For more information, please visit our dedicated website.

Lead: Dr Duncan Wagstaff

We are a network of clinicians, students and researchers, aiming to improve surgical and critical care in Low and Middle Income Countries (LMICs). Based at UCL, but with links to multiple institutions both in the UK and internationally, we connect people working across multiple clinical specialties (including Surgery, Anaesthetics, Intensive care, Obstetrics and Paediatrics) and academic disciplines (including Global Health, Economics, Education, Engineering and many more) thus maximising UCL’s potential to make a significant contribution to this rapidly-growing interdisciplinary field. Our focus is on two overlapping domains: research and quality improvement, and education and training. 

For example, within research and QI, we are partnering with the Collaboration for Research, Training, and Implementation in Critical Care in Asia and Africa (CCAA) to train LMIC clinicians in applied research methods; synthesise evidence of improvement activities in LMICs (ref); and co-design, deliver and evaluate multi-country quality evaluation and improvement studies.

Within our education workstream, we are building a Global Perioperative Care online MSc module to launch in September 2025, and also evaluating the impact and application of online education resources in resource-limited settings. 

We run monthly hybrid seminars at UCL to share learning, ideas and plans and would welcome any questions or expressions of interest. 

To find out more, contact Dr Duncan Wagstaff: d.wagstaff@ucl.ac.uk

Lead: Dr Sam Bampoe

We deliver local, national, and international collaborative clinical trials in surgery, anaesthesia, and perioperative medicine. We are consistently amongst the highest recruiting hospitals in our specialty across the country, supporting both locally developed studies (e.g. PQIP, SONAR1, the Little Journey and POM-MP) and other NIHR portfolio studies. UCL and UCLH are partnering with collaborators to explore the use of AI, machine learning and quantum computing in the perioperative space. The team also supports recruitment into multiple industry-collaboration studies, supporting our BRC objectives.

• Dr Abi Beane (Reader, University of Edinburgh)
• Professor Mike Grocott (University of Southampton)
• Professor Rashan Haniffa (University of Edinburgh)

• Professor Monty Mythen

• Professor Aidan Fowler (Honorary Professor of Practice)
• Professor Clifford Ko (Honorary Professor)
• Professor Duncan McPherson (Honorary Professor of Practice)
• Professor Paul Myles (Honorary Professor)
• Professor Stella Vig (Honorary Professor of Practice)