Pre-operative Risk Assessment of Surgical Site Infection After Cardiac Surgery
Pre-operative Risk Assessment of Surgical Site Infection After Cardiac Surgery
Surgical site infections (SSI) are serious complications accounting for 20% of all the
 healthcare-associated infections and are considered the second most frequent type of
 hospital-acquired infection in Europe and the United States. SSI after cardiac surgery is
 associated with delays to patient's discharge, readmissions and re-operations; and can result
 in increased hospital costs for staffing, diagnostics and treatment.

 Risk assessment has been identified as potentially useful intervention in SSI prevention and
 in identifying at risk populations who may benefit from specific interventions to reduce this
 possible complication of cardiac surgery. However, there is currently a lack of evidence as
 to which risk tools are the most valid and reliable to be used in clinical practice. The
 investigators developed and locally validated the Barts Heart Centre Surgical Infection Risk
 (B-SIR) tool to include patients with various types of cardiac surgeries and found that the
 B-SIR tool is a better tool in predicting SSI risk compared with the existing cardiac risk
 tools in the study population.

 However, various literatures recognised that the predictive performance of a risk model tends
 to vary across settings, populations and periods. Hence, the investigators aim to do a
 multi-centre validation of the newly developed B-SIR tool and apply all the other tools
 (Australian Cardiac Risk Index and Brompton and Harefield Infection Score) to identify what
 tool performs best that can potentially be use for the UK population. Further, the outcome of
 the study will be beneficial to future cardiac surgery patients to assess their risk of
 developing SSI and help identify those patients who may benefit from specific interventions.
 Existing patients' data, which will be anonymised, from the participating cardiac centres
 will be utilised to analyse and compare the performance of each risk tools.
Surgical site infections (SSI) are serious complications accounting for 20% of all the
 healthcare-associated infections and are considered the second most frequent type of
 hospital-acquired infection in Europe and the United States. The incidence of SSI in England
 at 30-days is 8.6% for coronary artery bypass graft (CABG) and 2.2% for non-CABG operations.
 SSI after cardiac surgery is associated with delays to patient's discharge, readmissions and
 re-operations; and can result in increased hospital costs for staffing, diagnostics and
 treatment.

 Risk assessment has been identified as potentially useful intervention in SSI prevention and
 in identifying at risk populations who may benefit from targeted interventions to reduce this
 possible complication of cardiac surgery. However, there is currently a lack of evidence as
 to which risk tools are the most valid and reliable to be used in clinical practice. The
 investigators developed and locally validated the Barts Heart Centre Surgical Infection Risk
 (B-SIR) tool to include patients with various types of cardiac surgeries and found that the
 B-SIR tool has a greater predictive power of SSI risk compared with the existing cardiac risk
 tools in the study population.

 However, various literatures recognised that the predictive performance of a risk model tends
 to vary across settings, populations and periods. Verification of the robustness and
 generalisability of a developed model is highly recommended in one or more external
 validation studies. Hence, the investigators aim to do a multi-centre validation of the newly
 developed B-SIR tool and apply all the other tools (Australian Cardiac Risk Index and
 Brompton and Harefield Infection Score) to identify what tool performs best that can
 potentially be use for the UK population.

 This study is a secondary data analysis that will utilise prospectively collected data that
 were locally collected in 6 UK cardiac centres for the National Institute for Cardiovascular
 Outcome Research (NICOR) and Public Health of England (PHE) Surgical Site Infection
 Surveillance. Data on various patients' risk factors will be collected and analysed to
 compare the ability of each risk assessment tool in predicting SSI after cardiac surgery. The
 outcome of this study will be beneficial to future cardiac surgery patients to assess their
 risk of developing SSI and help identify those patients who may benefit from targeted
 interventions.
Inclusion Criteria:

 1. >/= 18 years old at the time of surgery; and

 2. had a primary surgery (CABG, valve surgery or both) in the UK cardiac centres.

 Exclusion Criteria:

 1. patients undergoing grown-up congenital heart disease related surgery;

 2. patients with concurrent aortovascular surgery;

 3. patients who had ventricular-assist device (VAD), haemolung, impellar and/or
 extracorporeal membrane oxygenator (ECMO) before and/or after cardiac surgery;

 4. patients who had an open-chest immediately after surgery.