Cardiothoracic Interdisciplinary Research

Since the last Cardio-Thoracic Interdisciplinary Research Network (CIRN) update in the January 2021 edition, the collaborative has continued to develop academically minded healthcare professionals in cardiothoracic surgery and deliver some high-quality outputs. Most notably, “The early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019” has been published in collaboration with the COVIDSurg Collaborative in the JTCVS and the protocol for a further Cochrane Review “Antithrombotic treatment following coronary artery bypass grafting (CABG) Network Meta-Analysis” has been accepted. This has been supported by a successful application for a BHF CRC Research Development Fund grant. In addition, the collaboration has undertaken a rapid review of consent in adult cardiac surgery. This has involved the work of nearly 50 individuals, across 17 UK & Ireland Trusts and has collated data from 420 consent forms in under three weeks from conception of the audit! An incredible feat in and of itself. The results of this will hopefully be presented at the SCTS Annual Conference 2022 and will hopefully catalyse a larger program of work.

The focus of this update however will be on the NIHR Program Development Grant funded ... This work started following the James Lind Alliance Priority Setting Partnership in which 10 key research priorities were identified in adult cardiac surgery. “Infection Prevention” was one of these key priorities leading to the formation of a Clinical Study Group (CSG7) which includes patient and public representation, healthcare professionals from nursing, cardiac surgery, wound surveillance, infection control and microbiology and health service researches including representatives from Public Health England (PHE). Figure 1 illustrates some of the work that has underpinned this successful grant application.

This work will involve three distinct packages, which we hope, will ultimately facilitate a successful application for a Programme Grant for Applied Research (PGfAR) in 18 months’ time. The packages are as follows: 1. A review of all previous studies to identify patient factors that increase the risk of wound infection. These factors will then be used to develop a new risk prediction tool for adult cardiac surgery patients incorporating routinely collected data.

2. Different hospitals and frequently even different consultant teams utilise treatments or preventative strategies to reduce wound infection in a different manner. We hope to identify why this is the case and make recommendations as to how this might be modified.

3. Identification of factors limiting PHE monitoring of wound infection rates in adult cardiac surgery and development of a strategy to improve monitoring and increase the number of participating hospitals.

This work will allow the development and implementation of a new national wound infection prevention strategy to reduce the variation in care, rate of wound infection and antimicrobial resistance following adult cardiac surgery in UK centres.

Throughout the application, development and planning of this program of work there has been a committed focus on Patient and Public Involvement and Engagement (PPIE) through regular CSG7 meetings and direction from our PPIE Co-Leads, Keith Wilson and Jeremy Dearling. Jeremy Dearling has provided the following insight on the process so far ...

‘Everyone in the team, and the team is comprehensive in skills and experiences, brings a different perspective to the topic of surgical site infection, and in common with the growing trend to include the public and patient voice in all matters regarding public funded research, the PPIE contributors bring their own insights. As team members who understand the experience and impact of surgery because they have seen it or experienced it as members of the public’, they think of things that academic and clinical team members sometimes overlook, or take for granted.’ The ultimate hope is that this work will lead to the delivery of a multicentred, interdisciplinary led randomised control trial (RCT) that will utilise routinely collected data to stratify individuals undergoing adult cardiac surgery and then target wound infection prevention strategies to reduce the incidence of wound infection (surgical site infection) whilst minimising antimicrobial resistance. Figure 2 illustrates the likely overview of this trial.

The Cardio-Thoracic Interdisciplinary Research Network is always looking for individuals to get involved, whatever your profession or experience. If any of the work discussed or proposals below excite you please get in touch via Twitter @CIRNetwork or via email CIRNetwork@outlook.com.

EVERYONE IS WELCOME!

Expressions of interest welcome on the following projects ...

• Preventing racial bias in surgical site infection monitoring: a pilot study

• Consent in Adult Cardiac Surgery

TARGET SSI Trial https://le.ac.uk/cardiovascularsciences/about/heart-surgery/ national-cardiac-surgery-clinicaltrials-initiative/infection-prevention

Patient and Public Engagement Events – SCTS Annual Conference 2020 Webinar Series https://le.ac.uk/cardiovascularsciences/about/heart-surgery/eventsand-conferences

BHF Data Science https://www.hdruk.ac.uk/helpingwith-health-data/bhf-data-sciencecentre/ n