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April 28, 2004

Supplemental Oxygen and Risk of Surgical Site Infection—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(16):1956. doi:10.1001/jama.291.16.1958-b

In Reply: Dr Hopf and colleagues note that our protocol permitted management variability. Our "real world" design allowed us to evaluate the effect of oxygen as it would be used in practice—if the benefit of hyperoxia depends upon an unrealistically tight set of cofactors, then its usefulness as a routine intervention is questionable. We acknowledged the potential biases involved. However, given that the issue faced by anesthesiologists and surgeons was whether hyperoxia should become standard practice, the practical question of our study is whether any inequalities between the groups were so large as to have concealed a significantly beneficial effect of hyperoxia. We strongly doubt this to be true. In comparing our results with those of Greif et al,1 it is imperative to note critical differences in the patients studied. For example, 30% of their patients were transfused with an average of 3 units of blood, compared with 3% receiving an average of 1.4 units in our study. Transfusion affects oxygen physiology and causes immunomodulation.2 It is unclear what role this might have as a cofactor with respect to hyperoxia. Thus, our conclusion was not that hyperoxia has no usefulness, but that it was premature to use it as a routine measure until important limitations are identified. We agree that we did not disprove that oxygen can be useful. But we did show that simply "dialing up" the oxygen for every patient—as Hopf and colleagues describe it, "oxygen used without reference to its properties"—is not the answer.

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