Surgical Site InfectionNCT04762446
Pre-operative Risk Assessment of Surgical Site Infection After Cardiac Surgery
An observational study of Surgical Site Infection and Risk Assessment, run by Barts & The London NHS Trust at 3 sites in United Kingdom.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 18 to 120 years
- Conditions the study is for
- Surgical Site Infection, Risk Assessment, Cardiac Surgery
- How many people
- 6,379 participants
- Where
- 3 sitesUnited Kingdom
- Study dates
- 15 Jul 2022to 30 Nov 2023
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 120 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: All consecutive patients who underwent coronary artery bypass graft (CABG), valve surgery, or combined surgery in the UK cardiac centres between January 2018 - December 2019 will be considered for inclusion.
Who may be able to join
- >/= 18 years old at the time of surgery; and
- had a primary surgery (CABG, valve surgery or both) in the UK cardiac centres.
Who cannot join
- patients undergoing grown-up congenital heart disease related surgery;
- patients with concurrent aortovascular surgery;
- patients who had ventricular-assist device (VAD), haemolung, impellar and/or extracorporeal membrane oxygenator (ECMO) before and/or after cardiac surgery;
- patients who had an open-chest immediately after surgery.
Trial locations and contacts
3 sites in 1 country.
United Kingdom3 sites
Liverpool Heart and Chest Hospital
Liverpool
James Cook University Hospital
Middlesbrough
Oxford University Hospital
Oxford
About this study
Official title: Multi-centre Assessment of Existing Pre-operative Risk Assessment Tools for Predicting 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.
Read the detailed description
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.
- Conditions
- Surgical Site Infection, Risk Assessment, Cardiac Surgery
- Medical subject headings
- Surgical Wound Infection
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| SSI group | Participants who developed surgical site infection (SSI) based on the definition of Centre for Disease Control and Prevention. | |
| Non-SSI group | Participants who did not develop SSI. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Predictive power of the risk tools
The primary outcome will be the assessment and comparison of the predictive power of B-SIR, ACRI and BHIS tools. The predictive power of each risk tool will be determined using the area under the curve (AUC) from receiver operating characteristic (ROC) curve. AUC can be between 0.5 - 1; higher score (closer to 1) indicates greater predictive ability.
Measured: January 2018 - December 2019
Secondary outcomes (1)
Calibration scores of the risk tools
The secondary outcome will be the assessment and comparison of the calibration of scores of B-SIR, ACRI and BHIS tools. Hosmer-Lemeshow goodness of fit test will be utilised to determine calibration of scores. This will be done to examine the ability of each model to generate predictions that are on average close to the average observed outcome. For this test, a p-value that is not statistically significant (p > 0.05) will be considered to indicate a reasonable model fit.
Measured: January 2018 - December 2019
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Feb 2021
- Study start15 Jul 2022
- Primary completion30 Nov 2023
- Study completion30 Nov 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for Surgical Site InfectionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 6,379 participants (actual)
Sponsor and investigators
- Lead sponsor
- Barts & The London NHS Trust
- Sponsor type
- University, hospital or other
- Collaborators
- Liverpool Heart and Chest Hospital NHS Foundation Trust, University Hospitals, Leicester, Oxford University Hospitals NHS Trust, South Tees Hospitals NHS Foundation Trust, Cardiff and Vale University Health Board, Belfast Health and Social Care Trust
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04762446
- Sponsor's protocol ID
- 294270
- Status last verified
- Apr 2024
- First submitted
- 18 Feb 2021
- Last updated
- 10 Apr 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Lamagni T CK, Wloch C, Harrington P. The epidemiology of cardiac surgical site infection in Englad, 2018/19. 30th European Congress of Clinical Microbiology and Infectious Diseases. 2020; Paris, France: Clin Microbiol Infect 2020.
Magboo R, Drey N, Cooper J, Byers H, Shipolini A, Sanders J. Predicting cardiac surgical site infection: development and validation of the Barts Surgical Infection Risk tool. J Clin Epidemiol. 2020 Dec;128:57-65. doi: 10.1016/j.jclinepi.2020.08.015. Epub 2020 Aug 25.
PubMed 32853763Debray TP, Vergouwe Y, Koffijberg H, Nieboer D, Steyerberg EW, Moons KG. A new framework to enhance the interpretation of external validation studies of clinical prediction models. J Clin Epidemiol. 2015 Mar;68(3):279-89. doi: 10.1016/j.jclinepi.2014.06.018. Epub 2014 Aug 30.
PubMed 25179855Pennells L, Kaptoge S, White IR, Thompson SG, Wood AM; Emerging Risk Factors Collaboration. Assessing risk prediction models using individual participant data from multiple studies. Am J Epidemiol. 2014 Mar 1;179(5):621-32. doi: 10.1093/aje/kwt298. Epub 2013 Dec 22.
PubMed 24366051Royston P, Parmar MK, Sylvester R. Construction and validation of a prognostic model across several studies, with an application in superficial bladder cancer. Stat Med. 2004 Mar 30;23(6):907-26. doi: 10.1002/sim.1691.
PubMed 15027080Steyerberg EW, Moons KG, van der Windt DA, Hayden JA, Perel P, Schroter S, Riley RD, Hemingway H, Altman DG; PROGRESS Group. Prognosis Research Strategy (PROGRESS) 3: prognostic model research. PLoS Med. 2013;10(2):e1001381. doi: 10.1371/journal.pmed.1001381. Epub 2013 Feb 5.
PubMed 23393430Vergouwe Y, Moons KG, Steyerberg EW. External validity of risk models: Use of benchmark values to disentangle a case-mix effect from incorrect coefficients. Am J Epidemiol. 2010 Oct 15;172(8):971-80. doi: 10.1093/aje/kwq223. Epub 2010 Aug 31.
PubMed 20807737Bleeker SE, Moll HA, Steyerberg EW, Donders AR, Derksen-Lubsen G, Grobbee DE, Moons KG. External validation is necessary in prediction research: a clinical example. J Clin Epidemiol. 2003 Sep;56(9):826-32. doi: 10.1016/s0895-4356(03)00207-5.
PubMed 14505766
Study at a glance
From the registry record, last updated by the sponsor on 10 Apr 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Multi-centre Assessment of Existing Pre-operative Risk Assessment Tools for Predicting Surgical Site Infection After Cardiac Surgery
- ClinicalTrials.gov ID
- NCT04762446
- Acronym / sponsor ID
- 294270
- Conditions
- Surgical Site Infection, Risk Assessment, Cardiac Surgery
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 6,379 participants (actual)
- Lead sponsor
- Barts & The London NHS TrustUniversity, hospital or other
- Collaborators
- Liverpool Heart and Chest Hospital NHS Foundation Trust, University Hospitals, Leicester, Oxford University Hospitals NHS Trust, South Tees Hospitals NHS Foundation Trust, Cardiff and Vale University Health Board, Belfast Health and Social Care Trust
- Study start
- 15 Jul 2022 (actual)
- Primary completion
- 30 Nov 2023 (actual)
- Study completion
- 30 Nov 2023 (actual)
- First posted
- 21 Feb 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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.
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| SSI group | – | –Participants who developed surgical site infection (SSI) based on the definition of Centre for Disease Control and Prevention. |
| Non-SSI group | – | –Participants who did not develop SSI. |
Who may qualify
- Ages
- 18 to 120 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- All consecutive patients who underwent coronary artery bypass graft (CABG), valve surgery, or combined surgery in the UK cardiac centres between January 2018 - December 2019 will be considered for inclusion.
Key inclusion criteria (2 listed)
- >/= 18 years old at the time of surgery; and
- had a primary surgery (CABG, valve surgery or both) in the UK cardiac centres.
Key exclusion criteria (4 listed)
- patients undergoing grown-up congenital heart disease related surgery;
- patients with concurrent aortovascular surgery;
- patients who had ventricular-assist device (VAD), haemolung, impellar and/or extracorporeal membrane oxygenator (ECMO) before and/or after cardiac surgery;
- patients who had an open-chest immediately after surgery.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Predictive power of the risk tools
Time frame: January 2018 - December 2019
The primary outcome will be the assessment and comparison of the predictive power of B-SIR, ACRI and BHIS tools. The predictive power of each risk tool will be determined using the area under the curve (AUC) from receiver operating characteristic (ROC) curve. AUC can be between 0.5 - 1; higher score (closer to 1) indicates greater predictive ability.
1 secondary outcome
Calibration scores of the risk tools
Time frame: January 2018 - December 2019
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Apr 2024.
- BackgroundLamagni T CK, Wloch C, Harrington P. The epidemiology of cardiac surgical site infection in Englad, 2018/19. 30th European Congress of Clinical Microbiology and Infectious Diseases. 2020; Paris, France: Clin Microbiol Infect 2020.
- Background: PubMed 32853763Magboo R, Drey N, Cooper J, Byers H, Shipolini A, Sanders J. Predicting cardiac surgical site infection: development and validation of the Barts Surgical Infection Risk tool. J Clin Epidemiol. 2020 Dec;128:57-65. doi: 10.1016/j.jclinepi.2020.08.015. Epub 2020 Aug 25.
- Background: PubMed 25179855Debray TP, Vergouwe Y, Koffijberg H, Nieboer D, Steyerberg EW, Moons KG. A new framework to enhance the interpretation of external validation studies of clinical prediction models. J Clin Epidemiol. 2015 Mar;68(3):279-89. doi: 10.1016/j.jclinepi.2014.06.018. Epub 2014 Aug 30.
- Background: PubMed 24366051Pennells L, Kaptoge S, White IR, Thompson SG, Wood AM; Emerging Risk Factors Collaboration. Assessing risk prediction models using individual participant data from multiple studies. Am J Epidemiol. 2014 Mar 1;179(5):621-32. doi: 10.1093/aje/kwt298. Epub 2013 Dec 22.
- Background: PubMed 15027080Royston P, Parmar MK, Sylvester R. Construction and validation of a prognostic model across several studies, with an application in superficial bladder cancer. Stat Med. 2004 Mar 30;23(6):907-26. doi: 10.1002/sim.1691.
- Background: PubMed 23393430Steyerberg EW, Moons KG, van der Windt DA, Hayden JA, Perel P, Schroter S, Riley RD, Hemingway H, Altman DG; PROGRESS Group. Prognosis Research Strategy (PROGRESS) 3: prognostic model research. PLoS Med. 2013;10(2):e1001381. doi: 10.1371/journal.pmed.1001381. Epub 2013 Feb 5.
- Background: PubMed 20807737Vergouwe Y, Moons KG, Steyerberg EW. External validity of risk models: Use of benchmark values to disentangle a case-mix effect from incorrect coefficients. Am J Epidemiol. 2010 Oct 15;172(8):971-80. doi: 10.1093/aje/kwq223. Epub 2010 Aug 31.
- Background: PubMed 14505766Bleeker SE, Moll HA, Steyerberg EW, Donders AR, Derksen-Lubsen G, Grobbee DE, Moons KG. External validation is necessary in prediction research: a clinical example. J Clin Epidemiol. 2003 Sep;56(9):826-32. doi: 10.1016/s0895-4356(03)00207-5.
- GIRFT 2019Link provided by the sponsor.
- NICE SSI Prevention GuidelinesLink provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
3 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Surgical Site Infection and Risk Assessment, run by Barts & The London NHS Trust at 3 sites in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 10 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 3 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Predictive power of the risk tools (time frame: January 2018 - December 2019). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04762446, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Apr 2024.