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Jun 27, 2018
Effect of intraoperative hyperoxia on the incidence of surgical site infections: a meta-analysis
B. Cohen, Y.N. Schacham, K. Ruetzler, S. Ahuja, D. Yang, E.J. Mascha, A.B. Barclay, M.H. Hung, D.I.
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.
DOI: https://doi.org/10.1016/j.bja.2018.02.027