B Cohen1, Y N Schacham2, K Ruetzler3, S Ahuja3, D Yang4, E J Mascha4, A B Barclay3, M H Hung5, D I Sessler6. 1. Division 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. 2. Internal Medicine C, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. 3. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. 4. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. 5. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan. 6. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: DS@OR.org.
Abstract
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.
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 colorectalpatients (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.
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
Authors: Julien Demiselle; Enrico Calzia; Clair Hartmann; David Alexander Christian Messerer; Pierre Asfar; Peter Radermacher; Thomas Datzmann Journal: Ann Intensive Care Date: 2021-06-02 Impact factor: 6.925