• Sakina Bhaloo, James Glasbey, and Aneel Bhangu.
• Royal Surrey County Hospital, Birmingham, UK; NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, University of Birmingham, Birmingham, UK. Electronic address: s.bhaloo@nhs.net.
• Br J Anaesth. 2024 Dec 24.

AbstractPostoperative mortality in Africa is twice that of wealthier countries. The SMARTER trial underscores this critical issue and aims to address the high mortality rates by harnessing a readily available resource requiring minimal funding. Conducted in Mbale, Uganda, this innovative trial trained family members to monitor basic vital signs following surgery. This task is usually performed by healthcare workers who are often a limited resource in low- and middle-income settings. Although the results demonstrate a potential for increasing the capacity to rescue in the postoperative period, there is a need for further research to assess real-world effectiveness. Any improvement in patient monitoring would be limited by the system's capacity to respond effectively to escalations made by family members and the possible inaccuracy of their monitoring. Intervening earlier in the preoperative pathway can reduce the need to rescue postoperatively, but the SMARTER intervention has the potential to contribute to the larger effort needed to reduce surgical deaths globally in resource-limited settings.Copyright © 2024. Published by Elsevier Ltd.

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