Comment from Mayo, Jenny

As a NHSN user, I appreciate the opportunity to weigh in on opportunities to enhance the value of publically reported quality metrics that rely on the application surveillance definitions to different scenarios. Advancements in technology and technique can have a major impact on both patient outcomes, but also the risk stratification of a surgery. One such scenario is when HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is used in a colon or hysterectomy procedure. Unlike traditional chemotherapy, this treatment involves surgical removal of tumors followed by filling the abdominal cavity with heated (106-109F) chemotherapy agents that are circulated through the abdomen with a perfusion instrument for 30-120 minutes. Intentional patient cooling is often required to maintain appropriate core temperature. The advantages of this procedure include fewer systemic drug effects and reduced risk of cancer recurrence, but the procedure creates an increased surgery duration and an increased risk of SSI. "The incidence of surgical site infection (SSI) after CRS and HIPEC ranges between 11 and 46%. These patients are also at high risk of postoperative abdominal infections and septic complications, and a bacterial translocation during HIPEC has been hypothesized." Vallicelli, C.; Coccolini, F.; Sartelli, M.; Ansaloni, L.; Bui, S.; Catena, F. Antibiotic Prophylaxis for Surgical Site Infection in General Surgery: Oncological Treatments and HIPEC. Antibiotics 2022, 11, 43. https://doi.org/10.3390/antibiotics11010043. Colon and Hysterectomy are CMS reportable data metrics used to compare all hospitals, but not all hospitals are currently performing HIPEC. Inclusion of these cases greatly increases the risk of SSI and can falsely skew hospital performance data that affects both Medicare reimbursement and hospital reputation. I propose cases that undergo HIPEC be excluded from the Colon and HYST SIR unless a risk adjusted calculation is incorporated into procedures that include HIPEC.