Great to see Getting It Right the First Time (GIRFT) report on cardiothoracic services and GIRFT SSI audit. A couple of thoughts on current information related to SSI data management for SCTS/NICOR: shouldn't we be asking for deep incisional SSI to be included in GIRFT/NICOR data arrangements? The majority of GIRFT surgical categories already include the category 'deep incisional', but it is Excluded for cardiac (presumably because of traditional surgical view of superficial /deep SSI). By Excluding cardiac deep incisional SSI, we are ignoring exactly the type of SSI that drives readmission for SSI (mediastinitis and IE are serious SSI are reported by GIRFT, but these make up <10% of all cardiac SSI, nationally). A proximal deep incisional SSI is at greater risk of sinus and mediastinitis etc.
My next thought is around the recommendation for NICOR/SCTS to emphasise /record returns to theatre for SSI - I have worked with SCTS/NICOR dataset for many years and in my experience, 'return to theatre for bleeding' is a pretty contentious field. We have to be careful not to discourage clinicians to seek early return to theatre for mediastinitis and if applicable, IE (and/or deep incisional, if we get it in!), just because they don't want it 'recorded against them'. Delays in return to theatre increases risk the of sepsis and mortality.
I will finish by commenting that I think the GIRFT programme is extremely important (Cardiac SSI Network colleagues will know I am in strong support from talks on the matter!), I just worry that unless we say something, there is a risk of not getting the SSI bit right...
What do others think about the exclusion of deep incisional SSI??