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Effect of intraoperative hyperoxia on the incidence of surgical site infections: a meta-analysis
B Cohen1, Y N Schacham2, K Ruetzler3
1Division of Anesthesia, Critical Care and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Background:
Whether supplemental intraoperative oxygen reduces surgical site infections remains unclear. Recent recommendations from the World Health Organization and Center for Disease Control to routinely use high inspired oxygen concentrations to reduce infection risk have been widely criticized. We therefore performed a meta-analysis to evaluate the influence of inspired oxygen on infection risk, including a recent large trial.
Methods:
A systematic literature search was performed. Primary analysis included all eligible trials. Sensitivity analyses distinguished studies of colorectal and non-colorectal surgeries, and excluded studies with high risk of bias. Another post-hoc sensitivity analysis excluded studies from one author that appear questionable.
Results:
The primary analysis included 26 trials (N=14,710). The RR [95%CI] for wound infection was 0.81 [0.70, 0.94] in the high vs. low inspired oxygen groups. The effect remained significant in colorectal patients (N=10,469), 0.79 [0.66, 0.96], but not in other patients (N=4,241), 0.86 [0.69, 1.09]. When restricting the analysis to studies with low risk of bias, either by strict inclusion criteria (N=5,047) or by researchers' judgment (N=12,547), no significant benefit remained: 0.84 [0.67, 1.06] and 0.89 [0.76, 1.05], respectively.
Conclusions:
When considering all available data, intraoperative hyperoxia reduced wound infection incidence. However, no significant benefit remained when analysis was restricted to objective- or investigator-identified low-bias studies, although those analyses were not as well-powered. Meta-analysis of the most reliable studies does not suggest that supplemental oxygen substantively reduces wound infection risk, but more research is needed to fully answer this question.
Insights
Supplemental intraoperative oxygen may reduce surgical site infections, but this benefit disappears in high-quality studies. More research is needed to confirm if high inspired oxygen concentrations truly lower infection risk.
Area of Science:
- Anesthesiology
- Surgical Infection Prevention
- Evidence-Based Medicine
Background:
- The efficacy of supplemental intraoperative oxygen in preventing surgical site infections (SSIs) is debated.
- Recent guidelines recommending high inspired oxygen concentrations for SSI reduction face criticism.
- This meta-analysis evaluates the impact of inspired oxygen levels on infection risk.
Purpose of the Study:
- To conduct a meta-analysis assessing the influence of intraoperative inspired oxygen concentrations on surgical site infection risk.
- To include recent large clinical trials in the analysis to provide updated evidence.
- To critically evaluate the existing literature on perioperative oxygenation and SSI prevention.
Main Methods:
- A systematic literature search was performed to identify relevant randomized controlled trials.
- Primary analysis included all eligible trials, with subsequent sensitivity analyses based on surgery type (colorectal vs. non-colorectal) and risk of bias.
- Post-hoc analyses excluded studies from a specific author to assess potential bias.
Main Results:
- The primary analysis of 26 trials (N=14,710) showed a reduced risk of wound infection with high versus low inspired oxygen (RR 0.81 [0.70, 0.94]).
- This effect was significant in colorectal surgeries (RR 0.79 [0.66, 0.96]) but not in other surgeries (RR 0.86 [0.69, 1.09]).
- Sensitivity analyses excluding studies with high risk of bias found no significant benefit (RR 0.84 [0.67, 1.06] and RR 0.89 [0.76, 1.05]).
Conclusions:
- While initial analysis suggests intraoperative hyperoxia may reduce wound infection rates, this finding is not robust.
- When restricted to high-quality, low-bias studies, the protective effect of supplemental oxygen on wound infections was not significant.
- Further research is necessary to definitively determine the role of supplemental oxygen in preventing surgical site infections.
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