Effect of Perioperative Oxygen Supplementation on 30-day Surgical Site Infection Rate in Abdominal, Gynecologic, and Breast Surgery

Abstract

Background: Benefits and limitations of supplementation with 80% fraction of inspired oxygen for preventing surgical site infections have not yet been clearly defined. Some studies have reported benefits in colorectal surgery, whereas trials in abdominal and gynecologic surgery have reported either no effect or a deleterious effect. Methods: Controlled, randomized, assessor-blind multicenter trial, the ISO 2 study, comparing the effects of hyperoxygenation (fraction of inspired oxygen, 80%) with those of 30% oxygen on the frequency of surgical site infections in routine abdominal, gynecologic, and breast surgery on 434 patients. Patients not seen in consultation after discharge were contacted. Results: In total, 208 patients received 30% perioperative oxygen and 226 received 80%. There was no difference be-

Effect of Intraoperative High Inspired Oxygen Fraction on Surgical Site Infection, Postoperative Nausea and Vomiting, and Pulmonary Function

“…Nine studies (5,103 patients) reported on the incidence of SSI (table 1). 4 28 Seven studies used a standardized method for SSI assessment: three considered the ASEPSIS scoring system, 4,5,58 two used the definition of the Centers for Disease Control and Prevention, 30,63 and two considered a prospectively determined scoring system. 28,66 In all trials except one, 30 90-100% of patients received prophylactic antibiotics.…”

“…[4][5][6][7][27][28][29][30][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] Seven reports with additional data from 900 patients have not been considered for any previously published metaanalyses. [27][28][29][30]61,69,70 Two articles reporting on pulmonary outcomes 56 and PoNV, 7 respectively, were subgroup analyses of a multicenter study that reported on SSI. 5 Results of another multicenter study reporting on SSI and pulmonary outcomes 63 were reported in two further articles; one concentrated on pulmonary outcomes in obese patients 70 and the other on pulmonary outcomes in patients scheduled for laparotomy for ovarian cancer.…”

“…[20][21][22][23][24][25][26] A number of further relevant clinical trials studying these issues have been published recently. [27][28][29][30] The aim of our study was to update previously published meta-analyses, and to provide a comprehensive quantitative summary of the most important, potentially beneficial (decrease in the risk of SSI or PoNV) and harmful (increase in the risk of pulmonary complications) effects of intraoperative high inspired FIo 2 on surgical patients.…”

Evidence update on prevention of surgical site infection

“…It has been suggested that the true prevalence of SSI is underestimated, depending on surgical specialty, accepted and validated definitions and the comprehensiveness of postoperative surveillance [8][9] . When close post-discharge surveillance is included, particularly with the involvement of unbiased, trained and validated observers, SSIs have been reported to complicate 10-20% of surgical operations indicating that there is widespread underestimation of SSI rates across all classes of surgery [10][11][12][13][14][15][16][17][18] .…”

The WHO recommendation for 80% perioperative oxygen is poorly justified

“…On the other hand 7 trials including 2992 patients reported no benefit of 80% inspired oxygen (. Table 1) [2,12,13,15,20,26,28]. The WHO panel members based their recommendations on a meta-analysis of 11 randomized trials of supplemental oxygen during and after general anaesthesia.…”