Attila Podolyak1, Daniel I Sessler, Christian Reiterer, Edith Fleischmann, Ozan Akça, Edward J Mascha, Robert Greif, Andrea Kurz. 1. From the *Departments of General Anesthesiology, †Outcomes Research, and ‡Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; §Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria; ‖Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, Kentucky; and ¶Department of Anesthesiology and Pain Therapy, University of Bern, Bern, Switzerland.
Abstract
BACKGROUND: A follow-up analysis from a large trial of oxygen and surgical-site infections reported increased long-term mortality among patients receiving supplemental oxygen, especially those having cancer surgery. Although concerning, there is no obvious mechanism linking oxygen to long-term mortality. We thus tested the hypothesis that supplemental oxygen does not increase long-term mortality in patients undergoing colorectal surgery. Secondarily, we evaluated whether the effect of supplemental oxygen on mortality depended on cancer status. METHODS: Mortality data were obtained for 927 patients who participated in 2 randomized trials evaluating the effect of supplemental oxygen on wound infection. We assessed the effect of 80% vs 30% oxygen on long-term mortality across 4 clinical sites in the 2 trials using a Cox proportional hazards regression model stratified by study and site. Kaplan-Meier survival estimates were calculated for each trial. Finally, we report site-stratified hazard ratios for patients with and without cancer at baseline. RESULTS: There was no effect of 80% vs 30% oxygen on mortality, with an overall site-stratified hazard ratio of 0.93 (95% confidence interval [CI], 0.72-1.20; P = 0.57). The treatment effect was consistent across the 2 original studies (interaction P = 0.88) and across the 4 sites (P = 0.84). There was no difference between patients with (n = 451) and without (n = 450) cancer (interaction P = 0.51), with hazard ratio of 0.85 (95% CI, 0.64-1.1) for cancer patients and 0.97 (0.53-1.8) for noncancer patients. CONCLUSIONS: In contrast to the only previous publication, we found that supplemental oxygen had no influence on long-term mortality in the overall surgical population or in patients having cancer surgery.
BACKGROUND: A follow-up analysis from a large trial of oxygen and surgical-site infections reported increased long-term mortality among patients receiving supplemental oxygen, especially those having cancer surgery. Although concerning, there is no obvious mechanism linking oxygen to long-term mortality. We thus tested the hypothesis that supplemental oxygen does not increase long-term mortality in patients undergoing colorectal surgery. Secondarily, we evaluated whether the effect of supplemental oxygen on mortality depended on cancer status. METHODS: Mortality data were obtained for 927 patients who participated in 2 randomized trials evaluating the effect of supplemental oxygen on wound infection. We assessed the effect of 80% vs 30% oxygen on long-term mortality across 4 clinical sites in the 2 trials using a Cox proportional hazards regression model stratified by study and site. Kaplan-Meier survival estimates were calculated for each trial. Finally, we report site-stratified hazard ratios for patients with and without cancer at baseline. RESULTS: There was no effect of 80% vs 30% oxygen on mortality, with an overall site-stratified hazard ratio of 0.93 (95% confidence interval [CI], 0.72-1.20; P = 0.57). The treatment effect was consistent across the 2 original studies (interaction P = 0.88) and across the 4 sites (P = 0.84). There was no difference between patients with (n = 451) and without (n = 450) cancer (interaction P = 0.51), with hazard ratio of 0.85 (95% CI, 0.64-1.1) for cancerpatients and 0.97 (0.53-1.8) for noncancer patients. CONCLUSIONS: In contrast to the only previous publication, we found that supplemental oxygen had no influence on long-term mortality in the overall surgical population or in patients having cancer surgery.
Authors: Ozan Akca; Lorenzo Ball; F Javier Belda; Peter Biro; Andrea Cortegiani; Arieh Eden; Carlos Ferrando; Luciano Gattinoni; Zeev Goldik; Cesare Gregoretti; Thomas Hachenberg; Göran Hedenstierna; Harriet W Hopf; Thomas K Hunt; Paolo Pelosi; Motaz Qadan; Daniel I Sessler; Marina Soro; Mert Şentürk Journal: Turk J Anaesthesiol Reanim Date: 2017-08-01
Authors: Sarah Dehne; Verena Spang; Rosa Klotz; Laura Kummer; Samuel Kilian; Katrin Hoffmann; Martin A Schneider; Thilo Hackert; Markus W Büchler; Markus A Weigand; Jan Larmann Journal: Front Med (Lausanne) Date: 2021-11-26