Changes in Oxygen Saturation in the 72 Hours after Hip Surgery: The Effect of Oxygen Therapy

Abstract

The aim of this study was to investigate changes in oxygen saturation (SpO2) occurring during the three days following hip surgery in patients in this hospital and to determine to what extent SpO2 might be improved by oxygen therapy for 24 or 72 hours. Eighty-three patients (aged 43-96 years) scheduled for elective total hip replacement or emergency surgery for hip fractures were studied. Forty-four patients had 24 hour postoperative oxygen prescribed by their anaesthetist or surgeon; we randomized these to either continue oxygen for a total of three days (Group 1) or to discontinue oxygen after Day 1 (Group 2). Patients not prescribed oxygen by the surgeon or anaesthetist (n = 39) were randomly assigned either to receive oxygen for three days (Group 3) or not to receive oxygen (Group 4). Oxygen was administered through nasal cannulae at a flow of 2 l.min−1. SpO2 was measured every 10 seconds for three days and stored on computer disc. Percentage of time spent with SpO2 below 90% was used as an idex of desaturation. Patients receiving oxygen had significantly improved SpO2. In patients not receiving oxygen, desaturation was most severe on Days 1 and 2, improving somewhat on Day 3. On Day 2 desaturation was similar in Groups 2 and 4. When oxygen was not being administered males were significantly more desaturated than females. Our investigations indicate that following hip surgery poor saturation continues for at least two days and can be improved by oxygen therapy.

Dedicated hip fracture service: implementing a novel model of care

“…Standardized post‐operative management protocols were instituted to streamline patient recovery and rehabilitation . All patients at this institution receive post‐operative oxygen supplementation, in line with evidence supporting the routine use of oxygen therapy for the first 72 h after surgery . Routine mechanical and biochemical venous thromboprophylaxis, as well as preventative pressure sore dressings and antibiotic prophylaxis, are also utilized …”

Variable oxygen administration in surgical and medical wards evaluated by 30‐day mortality—An observational study

“…Previous trials in patients undergoing hip surgery have focused mainly on preventing hypoxia, and the studies we found examining post-operative oxygen administration, had no classification of hyperoxia. 28,29 . The effect of excessive oxygen administration compared to adequate oxygen administration in this group of patients seems to be inconclusive.…”

Emergency department management of hip fractures: Development of an evidence‐based clinical guideline by literature review and consensus

“…However, no clear statement is made about whether pulse oximetry should be continuous or intermittent. The rationale for this statement is based on the findings of Fugere et al 20 who reported that patients who did not receive supplemental oxygen following surgical repair of hip fracture had a greater incidence of desaturation in the first 48 h (oxygen saturation falling below 90%) than patients who did receive supplemental oxygen. Although no attempt was made to infer the causes for this phenomenon, this study did note that normal practice was to keep patients in the supine position for the first 48 h postoperatively.…”