BriSPOCC- Surgical and Peri-operative Complex Interventions

Meet the team

Rob Hinchliffe

Ronelle Mouton

Shelley Potter

Chris Twine (NBT)

Karen Coulman

Research co-ordinator

Aisling Cashell

Methodological expertise

Prof Nicky Walsh (UWE)

Prof Fiona Cramp (UWE)

Kerry Avery (UoB)

Leila Rooshenas & Ava Lorenc (UoB)

Current trainees

University of Bristol NIHR Academic Clinical Fellows (NIHR ACFs)

Richard Armstrong

Emma Sewart

Kitty Wong

Lucy Elliott

Suzie Harrogate

NIHR Specialised Foundation Programme Trainees (NIHR SFPs)

George Hudson

Rachel Lowe

Penelope Sucharitkul

MD & PhD students

Ewa Zywicka

Emily Britton

Aleksandra Staniszewska

National & International Links & Collaborations 

Royal College Surgeons of England

ESVS (Chair);




Linder Foundation (Rob H Linder Foundation Chair at Royal College of Surgeons of England) 

European Vascular Research Collaborative (EVRC) 

Rob H Chair of European research Hub, European Society of Vascular and Endovascular Surgery

University of Southern Denmark – Rob H adjunct professor at the Faculty of Health Sciences, University of Southern Denmark.

Patient & public involvement

Bristol Vascular PPI group

Tobacco cessation PPI group

We are a multidisciplinary collaborative group of clinicians, allied health professionals and researchers with a focus on developing and evaluating complex interventions related to surgery and peri-operative care.

Mission Statement

Surgery is an important intervention that saves lives and restores health. On average, every person will undergo approximately six surgical procedures in their lifetime. Modern surgery is complex and only successful if delivered by teams of multiple healthcare professionals who work together to deliver the best care. Our team is dedicated to design and evaluate optimal interventions that improve the care of people preparing for, undergoing or recovering from surgery.

Current research themes

National & International clinical trials

  • Lolipop (NIHR HTA)
  • EndoNET (NIHR HTA)

Real world data: Developing target trials

  • Brighter (NIHR RfPB)

Methodology: Reporting complex interventions

  • Framework development
    • Anaesthesia
    • Lower limb endovascular interventions
  • Locoregional outcome reporting in neoSACT trials (PRECENDENT)

Core outcome sets:

Shelley breast surgery CoS

Diabetic foot CoS (final stage – consensus meeting in January)

Deep venous disease CoS (first stage published – at the Delphi stage)



Intervention development

  • FLAME – Flat symmetry After MastEctomy for breast cancer (Flat Friends)
  • Decision support for breast cancer surgery
  • Complex care in vascular surgery

Feasibility work

  • After Breast Cancer (ABC) (NIHR RfPB)
  • ANTHEM (ABS & Above and Beyond)

Recent publications  

Real world data theme

  • Hutchings A et al. Effectiveness of emergency surgery for five common acute conditions: an instrumental variable analysis of a national routine database. Anaesthesia. 2022 Aug;77(8):865-881.
  • Johnson et al. Long-term patient-reported outcomes of immediate breast reconstruction after mastectomy for breast cancer: population-based cohort study Br J Surg 2023 Sep 27:znad276  doi: 10.1093/bjs/znad276
  • Mohiuddin et al. Secondary healthcare costs after mastectomy and immediate breast reconstruction for women with breast cancer in England: population-based cohort study Br J Surg. 2023 Aug 11;110(9):1171-1179. doi: 10.1093/bjs/znad149.
  • Johnson et al. Impact of procedure type on revisional surgery and secondary reconstruction after immediate breast reconstruction in a population-based cohort Br J Surg . 2023 May 16;110(6):666-675.  doi: 10.1093/bjs/znad050.
  • Hutchings A, et al. Impact of the first wave of COVID-19 on outcomes following emergency admissions for common acute surgical conditions: analysis of a national database in England. Br J Surg. 2022 Sep 9;109(10):984-994.

Intervention development theme

  • Griffin et al. Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review Ann Surg Oncol 2023 Sep 25.  doi: 10.1245/s10434-023-14294-6.
  • Miller RL et al. Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention. BMJ Open. 2022 Oct 21;12(10):e062729.

Feasibility work

  • Davies et al Current practice and provision of oncoplastic breast-conserving surgery in the UK: results of the ANTHEM national practice questionnaire  Cancer Res Treat 2023 Jul;200(2):163-170.  doi: 10.1007/s10549-023-06924-0. Epub 2023 May 22.


(PROTECTOR) perioperative tobacco cessation theme

  • Harrogate S, Barnes J, Thomas K, Isted A, Kunst G, Gupta S, Rudd S, Banerjee T, Hinchliffe RJ, Mouton R.  Peri-operative tobacco-cessation interventions: a systematic review and meta-analysis. Anaesthesia Journal 2023

Developing reporting standards for complex interventions

  • Zywicka EM, McNally, E, Elliott L, Twine CP, Mouton R, Hinchliffe RJ. Exploring the reporting standards of randomized control trials involving endovascular interventions for peripheral arterial disease: A systematic review. European journal of Vascular and Endovascular Surgery 2023
  • L. Elliott, K. Coulman, N. Blencowe, M Qureshi, K. Siang Lee, R.J. Hinchliffe, R. Mouton. Reporting standards of mode of  anaesthesia as an intervention in randomised controlled trials: a systematic review. Anaesthesia 2021; 76(6): 832-836
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