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Supplemental Oxygen and Surgical Site Infection in Colorectal Surgery: A Systematic Review and Meta-analysis
Scott K Shaffer1, Tito D Tubog2, Terri D Kane3
1is a full time assistant professor at Texas Wesleyan University Graduate Programs of Nurse Anesthesia.
Abstract:
Surgical site infection (SSI) is a common preventable iatrogenic infection following surgery with an approximated overall occurrence of 2-4%. Despite numerous studies, controversies still exist regarding the efficacy, safety, and cost effectiveness of strategies to decrease SSI. The World Health Organization issued recommendations for the prevention of SSIs including oxygenation with 80% fraction of inspired oxygen (FiO2). The primary outcome of our systematic review and metaanalysis was the effect of high inspired FiO2 related to SSI in the colorectal surgery population. Secondary outcomes included incidence of anastomotic leaks and length of hospital stay. Eleven trials consisting of 8245 were included in the analysis. We found moderate quality of evidence that 80% FiO2 was not effective in reducing SSI (RR, 0.91; 95% CI, 0.74 to 1.13; P = .41) anastomotic leaks (RR, 0.75; 95% CI, 0.53 to 1.06; P = 0.10). Conversely, we found low quality evidence of no effect on length of stay measured in days (MD, 0.39; 95% CI -0.59 to 1.36; P = 0.44). Although additional studies are required to decrease heterogeneity of the studies, the current review showed high FiO2 does not decrease the incidence of SSI in the colorectal surgery population.
Insights
High fraction of inspired oxygen (FiO2) did not reduce surgical site infections (SSIs) in colorectal surgery patients. This systematic review found no significant benefit for preventing SSIs or anastomotic leaks.
Area of Science:
- Medical research
- Surgical outcomes
- Infectious disease prevention
Background:
- Surgical site infection (SSI) is a common complication, affecting 2-4% of surgeries.
- Strategies to reduce SSI are debated, including WHO recommendations for high inspired oxygen (80% FiO2).
Purpose of the Study:
- To evaluate the effectiveness of high inspired FiO2 in preventing SSIs in colorectal surgery.
- To assess the impact of high FiO2 on anastomotic leaks and hospital stay.
Main Methods:
- Systematic review and meta-analysis of eleven trials.
- Inclusion of 8245 patients undergoing colorectal surgery.
- Primary outcome: SSI incidence; Secondary outcomes: anastomotic leaks and length of hospital stay.
Main Results:
- Moderate quality evidence shows 80% FiO2 is ineffective in reducing SSI (RR, 0.91; P = .41).
- No significant reduction in anastomotic leaks (RR, 0.75; P = 0.10) or length of stay (MD, 0.39 days; P = 0.44) was observed.
- Low quality evidence indicated no effect on length of stay.
Conclusions:
- Current evidence suggests high inspired FiO2 (80%) does not decrease SSI incidence in colorectal surgery.
- Further research is needed to address study heterogeneity and confirm findings.
- The efficacy and cost-effectiveness of high FiO2 for SSI prevention remain uncertain.
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