Project title: Understanding and Preventing Surgical Site Infection in Hand Trauma

Grant Holder: Justin Wormald

Position: DPhil Candidate, University of Oxford and Plastic Surgery SpR

Date of award

16/9/2020

Start date for research

30/9/2020

Date of report

27/9/2022

Grant Awarded (i.e. £10,000)

£50,000

Is this an interim, or final, report

Interim

Summary of project/progress /findings

This grant has supported years one and two of my doctoral research at the University of Oxford.

Progress:

I conducted a systematic review of all hand trauma surgery research to assess the infection risk in the published data. I included 201 studies, evaluating 314,364 patients who had undergone hand trauma surgery. Looking across all studies, I found that infection risk ranged from 0% to over 47%, with the average risk somewhere between 5% and 10%. I then undertook novel and complex statistical analysis of this data and have produced accurate summary risk data for all hand trauma, with sub-group analyses for the most common injury types and surgical procedures.

Building on my systematic review findings, I utilised novel clinical research methods to acquire a very large dataset to generate highly accurate infection risk figures. I used Hospital Episode Statistics data: routinely collected healthcare data stored by the NHS for governmental reimbursement. I re-purposed this data for surgical outcomes analysis and created a mega-dataset of all patients who were admitted to an NHS hospital for hand trauma surgery over the last 20 years, totalling over 19 million patient records. I then divided the data set into cohorts, defined by injury type. We are now in the process of analysing this data to determine the number of patients re-admitted for infection after hand trauma surgery. This will provide highly accurate information on the most severe type of post-operative infection – those that need repeat surgery or hospital admission.

What is the relevance/value of this research to hand surgery:

This is one of the largest systematic reviews ever performed in hand surgery. To achieve this, I adopted an innovative, trainee collaborative approach, training junior trainees in review methodology and accrediting them with co-authorship.

We will be able to generate risk data for the most common hand injuries based on cohorts ranging from 30,000 - 100,000 patients, the largest studies of infection in hand trauma to date. This information can then be used to reliably inform patients of their risk of severe post-operative infection, which will build into transparent shared decision making between patients with hand and wrist injury and their surgeons.

The results of my systematic review have directly informed a new national guideline for Hand Surgery, co-badged by the British Society for Surgery of the Hand (BSSH) and the Getting it Right First Time (GIRFT) initiative.

Please list presentations based on work performed in this study

1. Surgical site infection following surgery for hand trauma: a systematic review and meta-analysis. J Wormald, A Shaw, A Baldwin, H Nadama, J Rodrigues, J Cook, D Prieto-Alhambra, M Costa. Stoke Mandeville Symposium – Ganga Prize Competition, 14^th December 2021

2. Epidemiology of acute flexor tendon injury and an analysis of severe adverse outcomes – a study of 101,559 patients in England and Wales. J Wormald, J Lane, M Ng, J Mawhinney, D Furniss. BSSH Autumn Scientific Meeting, 9-10^th September 2021, Oxford, UK

Please list publications based on work performed in this study

1. Tendon Disorders of the Hand and Wrist: IFSSH/FESSH Instructional Course Book 2022”.Chapter 1 / Epidemiology of flexor tendon injury

Please state what additional research this study has/is leading to

This work has contributed towards the development of the HAWAII Trial – a multicentre feasibility RCT of antimicrobial sutures in hand and wrist trauma surgery.

Please list any further funding or grant applications (with outcome), which have resulted from the award of this grant

I was awarded a NIHR Doctoral Research Fellowship in my second year of my DPhil.

How has this grant awards helped your career development?

This grant has led to work which has been recognised with the following prizes:

1. Rosetrees Essay Prize 2021 – Runner Up, May 2022, Awarded by the Royal College of Surgeons

2. BSSH Best Poster Presentation, September 2021, Awarded by the British Society for Surgery of the Hand (BSSH)

3. Botnar Research Centre Student Symposium 2021 Presentation Prize, June 2021, Awarded by NDORMS Head of Department