Observations demand inquiry
But Faraday's report, which was published this week in the Annals of Surgery, makes some observations that should provoke more inquiry.
The paper shows that patients who incurred a wound infection requiring antibiotic treatment in the past were three times more likely to develop a painful, costly infection related to a subsequent surgery than surgical patients who hadn't had a prior infection.
That was true after Faraday adjusted for all sorts of confounders, such as age, co-morbidities, and medications, he says.
"One of the reasons we are so concerned about the potential for punitive action is that we controlled for all the things that CMS wants us to do to prevent infections," says Faraday, an associate professor of anesthesiology and critical care medicine.
"We controlled for how you prep the skin, how you administer the antibiotics, and make sure antibiotics are given on time. And we still found that there was a much higher risk if a patient had a prior infection."
Additionally, he says, the CMS policy is not designed to penalize those hospitals that have higher rates of surgical site infections, "but to penalize any hospital, regardless of what the rate is, because if (any patient) develops one of these infections where you are, you're going to suffer some financial penalty."
Faraday and colleagues propose that there's an underlying genetic predisposition to surgical infections in some people, which is why these patients contracted their first infection and why they are much more likely to suffer one again when they have surgery.
"If you've had a spontaneous infection in the past, that might be a clue that the immune system in your skin, or some other cells that go to your skin to treat infection so that it doesn't become a problem for you—that somewhere along the line your mechanism may be different," Faraday says.
"We all get a cut sometimes in our daily lives, and we're all exposed to bacteria, but most of us will never experience a clinical infection of our skin."