• Report shows high rate of surgical site infections after cardiac surgery at St George’s Hospital in London
  • Investigation carried out after higher than expected death rate
  • Trust says service is safe but work continues “to deliver further improvement”

A major teaching hospital is still working to improve its heart surgery unit after high infection rates and a larger than expected number of deaths.

A report into cardiac surgery at St George’s University Hospitals Foundation Trust looked at data from 2013 to late 2017 and found the team “had a significant problem with surgical site infections and deep sternal infections two years ago”.

While one patient died of an MRSA infection in 2017, the document said the indications were that in the six months up to October 2017, the death rate was as expected.

The review, completed in October and presented to the trust’s board privately in November, was released to HSJ under the Freedom of Information Act.

It said “the cardiac surgical team have had a difficult 24 month period” and “the mortality signal in cardiac surgery is a cause for concern”.

Investigators carried out a case note review of deaths and the report said since then “pathways within the service have been explored and changes implemented”.

It added that the multidisciplinary team had “worked hard” to bring the surgical site infection rate down from six per 100 to 2.4 per 100.

There are currently six substantive cardiac surgeons at the trust, led by Nick Bunce, who has been the clinical lead for cardiac surgery since August 2014.

In June, the National Institute for Cardiovascular Outcome Research issued an alert over the survival rate among the 2,505 patients the team saw over a period from 2013 to 2016. The data showed a risk adjusted survival rate of 96.8 per cent against a predicted rate of 98.3 per cent. In response, the trust set up a working group led by the medical director and including the chief nurse, HR director and chief operating officer.

The trust found no individual surgeon was an outlier and the acuity of the caseload might not have been fully reflected in the NICOR risk weighting. Much of the work was complex and three patients had previously been turned down for surgery by other trusts or other surgeons at St George’s.

The trust’s FOI response redacted parts of the report because they related to “ongoing investigations”.

A trust spokesman said the cardiac review was complete but “there continues to be work within the service to deliver further improvements”. He could not provide details on what this work was.

In a statement, the trust said: “The cardiac service we provide for patients is safe.

“We have introduced a number of changes to the service; these include improvements to the admission and pre-operative management of patients; documentation during procedures; as well as post-operative care. We have also taken steps to strengthen team working within the department.

“The service is fully staffed and fully operational, and St George’s is continuing to deliver a wide range of local and tertiary services for cardiac patients.”