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April 20, 2009

Perioperative Supplemental Oxygen Therapy and Surgical Site Infection: A Meta-analysis of Randomized Controlled Trials

Author Affiliations

Author Affiliations: Department of Surgery, Price Institute of Surgical Research (Drs Qadan and Mahid), and Departments of Anesthesiology and Perioperative Medicine (Dr Ak[[ccedil]]a), Epidemiology and Population Health (Dr Hornung), and Surgery (Dr Polk), University of Louisville School of Medicine, Louisville, Kentucky; and Outcomes Research Consortium, Louisville (Dr Ak[[ccedil]]a).

Arch Surg. 2009;144(4):359-366. doi:10.1001/archsurg.2009.1

Objective  To conduct a meta-analysis of randomized controlled trials in which high inspired oxygen concentrations were compared with standard concentrations to assess the effect on the development of surgical site infections (SSIs).

Data Sources  A systematic literature search was conducted using the MEDLINE, EMBASE, and Cochrane databases and included a manual search of references of original articles, poster presentations, and abstracts from major meetings (“gray” literature).

Study Selection  Twenty-one of 2167 articles met the inclusion criteria. Of these, 5 randomized controlled trials (3001 patients) assessed the effect of perioperative supplemental oxygen use on the SSI rate. Studies used a treatment-inspired oxygen concentration of 80%. Maximum follow-up was 30 days.

Data Extraction  Data were abstracted by 3 independent reviewers using a standardized data collection form. Relative risks were reported using a fixed-effects model. Results were subjected to publication bias testing and sensitivity analyses.

Data Synthesis  Infection rates were 12.0% in the control group and 9.0% in the hyperoxic group, with relative risk reduction of 25.3% (95% confidence interval [CI], 8.1%-40.1%) and absolute risk reduction of 3.0% (1.1%-5.3%). The overall risk ratio was 0.742 (95% CI, 0.599-0.919; P = .006). The benefit from increasing oxygen concentration was greater in colorectal-specific procedures, with a risk ratio of 0.556 (95% CI, 0.383-0.808; P = .002).

Conclusions  Perioperative supplemental oxygen therapy exerts a significant beneficial effect in the prevention of SSIs. We recommend its use along with maintenance of normothermia, meticulous glycemic control, and preservation of intravascular volume perioperatively in the prevention of SSIs.