Beldi speculated that talking about topics that did not involve the surgery "may represent a lack of concentration by the surgical team."
Contacted by e-mail in Berne, Beldi explained that noise is "the only factor that can be assessed objectively. Noise is not just speaking about casual things, but also (includes people) giving strict instructions that might be associated with increased noise."
"We rather think that noise is a surrogate for a difficult operation and therefore is associated with complications," he wrote in his e-mail response.
Of course, it may be that some higher noise levels in the surgeries with resulting surgical site infections were related to machinery, surgical instruments, monitors, alarms, and background noise associated with a more difficult procedure. That "could explain the association between volume and SSI," the researchers said in their published report.
Reducing surgical site infections is important in the U.S. for a number of reasons. They increase length of stay by weeks, increase cost of care, and in the near future will lead to reduced reimbursement when they occur in Medicare beneficiaries, according to provisions in the Patient Protection and Affordable Care Act. So, any hints about how to reduce them shouldn't be ignored.