The CMS’s never events include surgical site infections, which was the most common never event to occur in this study. As the list of errors to be eliminated grows, so does concern over the ability to avoid many of these errors. SSIs fall into a unique category that confers an appearance of simple preventability; however, evidence exists that nosocomial infections and SSIs included in the reimbursement charge are not preventable in all cases or in nearly all cases. It has been estimated that up to 60 % of SSIs are preventable and that certain external patient characteristics (age, sex, chronic conditions) and procedure-related, non-modifiable variables warrant disqualification of SSI as never events [5, 11]. Therefore, this reimbursement change promoted by CMS lacks an evidence-based approach and will likely negatively impact care. Though hospitals will attempt to minimize the rate of nosocomial infections, these infections cannot be zero, further highlighting the fact that an evidence-based approach in developing a list of complications was omitted. Prevention of SSIs may be more beneficial than actually treating them, as it is estimated that at least 20 % of all nosocomial infections are probably avoidable [14]. Without question preventing infections through measures such as handwashing, prophylactic antibiotics and hospitals adopting stricter infection control guidelines should be done. Not all infections can be prevented, because prevention measures focus on exogenous sources or reasons for infection and ignore other important factors, host response and pathogen virulence, which cannot be altered [15].

Obesity has been shown to increase the risk for nosocomial infections and postoperative SSI [16

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