Background: Surgery is an intrinsic component of healthcare, estimated to be involved in the treatment of 28-32% of the global burden of disease. Research is crucial to improving the quality of surgical care and thus patient outcomes. The aim of this study was to analyse global patterns of public and philanthropic investment in surgical research.
Methods: Publicly available databases of human surgical research funding awards between 2016 and 2020 were searched. Awards were categorized by surgical specialty, cross-cutting research theme, and phase of research.
Results: A total of 8042 awards were identified, with a total investment of $3.48 billion between 2016 and 2020 (approximately $0.7 billion annually), contrasting with $24.5 billion for cancer research in the same interval. Preclinical research received most of the funding ($2.46 billion (70.7%)), clinical trials received $0.72 billion (20.6%), and public health research received $0.30 billion (8.6%). By cross-cutting research theme, the largest investment was into intraoperative research ($1.4 billion (40.94%)), followed by postoperative research ($0.76 billion (21.9%)), preoperative/neoadjuvant studies ($0.43 billion (12.3%)), and interventional radiology ($0.04 billion (1.2%)). Global surgery was the least well-funded area of research ($0.03 billion (0.8%)).
Conclusion: Surgical research remains underfunded in comparison with other specialties, with most investment directed towards preclinical research, not directly involving patients. Only a small proportion was invested in clinical trials, public health, and global surgery. These findings limit the impact of surgical research on improving population health and contrast starkly with the ubiquity of surgical treatments in the management of the global burden of disease. Urgent prioritization of surgical research and evaluation of priorities in research investment are required, to reflect surgery's pivotal role in global healthcare.
Plain language summary
Surgery is key to the treatment of many healthcare conditions across the world. However, surgical research has in the past received less funding than other areas of medicine. This study looked at the investment of a total of $3.48 billion of public and charitable funding for surgical research between 2016 and 2020. Most money (over 70%) went to early-stage research on surgical techniques and devices that did not directly involve patients, while clinical trials and public health studies received much less support. The study revealed inequalities in the distribution of funding. High-income countries received most investment and spending on surgical research in low-income and middle-income countries was minimal. Cancer surgery research also received a relatively small amount of funding, despite its important role in cancer treatment. Additionally, women researchers received fewer funding awards than men. The findings suggest that surgical research needs greater investment, particularly in areas such as global surgery, public health, and clinical trials. Increasing international collaboration, supporting a broad diversity of researchers, and prioritizing research that directly reaches patients worldwide could help address these gaps.
© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.
Keywords：global funding; surgical research; content analysis; public funding; philanthropic investments
背景: 手术是医疗保健的一个重要组成部分，估计在全球疾病负担的治疗中占28-32%。研究对于改善外科护理质量和患者预后至关重要。本研究旨在分析全球公共和慈善资金在手术研究中的投资模式。
方法: 搜索了2016年至2020年期间公开发布的有关人类外科手术研究资助的数据库。将奖项按外科专业、跨学科研究主题和研究阶段进行分类。
结果: 在2016年至2020年间，共识别出8,042项资助，总投资额为34.8亿美元（每年约7亿），相比之下，在同一时期癌症研究的总投资额为245亿美元。基础研究获得了最多的资金（24.6亿美元，占70.7%），临床试验获得7.2亿美元（20.6%），公共卫生研究获得3亿（8.6%）。按跨学科研究主题划分，最大的投资是术中研究（14亿美元，占比40.94%），其次是术后研究（7.6亿美元，占21.9%）、术前/新辅助研究（4.3亿美元，占12.3%）和介入放射学（4,000万美元，占1.2%）。全球外科手术的研究是最不受重视的领域（3,000万美元，占0.8%）。
结论: 与其他专业相比，手术研究的资金仍然不足，大部分投资集中在不直接涉及患者的早期基础研究上。仅有很小一部分资金投向临床试验、公共卫生和全球外科手术。这些发现限制了手术研究对改善人口健康的影响力，并且与手术治疗在全球疾病负担管理中的普遍性形成了鲜明对比。迫切需要优先考虑手术研究并评估研究投资的优先事项，以反映手术在全球医疗保健中的核心作用。
简易语言摘要
手术是全球许多医疗条件治疗的关键。然而，与医学其他领域相比，外科手术的研究在过去获得的资金较少。这项研究考察了在2016年至2020年间总计34.8亿美元的公共和慈善资金用于外科手术研究的投资情况。大部分资金（超过70%）流向了早期阶段的基础性外科技术和设备研究，并没有直接涉及患者，而临床试验和公共卫生研究则得到了相对较少的支持。该研究表明存在资金分配不均的问题。高收入国家获得了最多的投资，而在低收入和中等收入国家的手术研究支出却非常少。尽管癌症手术在癌症治疗中扮演重要角色，但其获得的资金也相对较少量。此外，女性研究人员比男性获得了更少的研究资助。这些发现表明外科手术研究需要更大的资金投入，特别是在全球外科、公共卫生以及临床试验等领域。增加国际协作，支持多样化的研究人员，并优先考虑直接惠及世界各地患者的临床研究可以帮助弥补这一缺口。
© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.
