High-concentration oxygen and surgical site infections in abdominal surgery: a meta-analysis

Abstract

Background: There has been recent interest in using high-concentration oxygen to prevent surgical site infections (SSIs). Previous meta-analyses in this area have produced conflicting results. With the publication of 2 new randomized controlled trials (RCTs) that were not included in previous meta-analyses, an updated review is warranted. Our objective was to perform a meta-analysis on RCTs comparing high-and low-concentration oxygen in adults undergoing open abdominal surgery. Methods:We completed independent literature reviews using electronic databases, bibliographies and other sources of grey literature to identify relevant studies. We assessed the overall quality of evidence using grade guidelines. Statistical analysis was performed on pooled data from included studies. A priori subgroup analyses were planned to explain statistical and clinical heterogeneity. Results:Overall, 6 studies involving a total of 2585 patients met the inclusion criteria. There was no evidence of a reduction in SSIs with high-concentration oxygen (risk ratio 0.77, 95% confidence interval 0.50-1.19, p = 0.24). We observed substantial heterogeneity among studies. Conclusion: There is moderate evidence that high-concentration oxygen does not reduce SSIs in adults undergoing open abdominal surgery.Contexte : On observe depuis peu un intérêt à l'endroit de l'oxygène à concentration élevée pour prévenir les infections de plaies opératoires. Les méta-analyses réalisées dans le passé à ce sujet ont donné des résultats divergents. Compte tenu de la publication de 2 nouveaux essais randomisés et contrôlés (ERC) qui n'ont pas été inclus dans les méta-analyses précédentes, une nouvelle revue de la situation s'imposait. Notre objectif était donc d'effectuer une méta-analyse des ERC, qui ont comparé l'oxygène à concentration élevée et faible chez des adultes soumis à une chirurgie abdominale ouverte.Méthodes : Nous avons effectué des analyses indépendantes de la littérature à partir de bases de données électroniques, de bibliographies et autres éléments de la littéra-ture « grise » pour identifier les études pertinentes. Nous avons classé la qualité globale des données probantes selon les lignes directrices de catégorisation. L'analyse statistique a porté sur les données regroupées des études incluses. Des analyses de sous-groupes ont été planifiées a priori pour expliquer l'hétérogénéité statistique et clinique.Résultats : En tout, 6 études regroupant 2585 patients répondaient aux critères d'inclusion. On n'a noté aucune preuve de réduction des infections de plaies opératoires associées à l'oxygène à concentration élevée (risque relatif 0,77, intervalle de confiance de 95 % 0,50-1,19, p = 0,24). Nous avons observé une forte hétérogénéité entre les études. Conclusion :On dispose de données probantes acceptables selon lesquelles l'oxygène à concentration élevée ne réduit pas les infections de plaies opératoires chez les adultes soumis à une chirurgie abdominale ouverte. Surgical site infections (SSIs) are a source of patient morbidity and mortali...

High inspired oxygen versus low inspired oxygen for reducing surgical site infection: a meta‐analysis

“…In this study, our pooled results failed to demonstrate the advantage of supplemental inspired oxygen in reducing SSIs when all types of surgery were considered together. This finding was similar to the results of three published meta‐analyses . However, it should be noted that a significant heterogeneity was presented among all included RCTs.…”

“…After the elimination of 1917 irrelevant records, 29 citations remained and were retrieved for a more detailed evaluation. Of these, two non‐randomized studies , one non‐comparative study and nine meta‐analyses were excluded. Three studies with no SSI data were also excluded .…”

“…However, the conclusions have reached no consensus. As a result, systematic reviews were continuously performed to statistically analyse the study data collected from individual trials . A recent meta‐analysis focusing on the rate of SSIs after caesarean sections included four studies .…”

Oxygen therapies and their effects on wound healing

“…Although some previous meta‐analyses have shown no benefit of the supplemental inspired oxygen, these meta‐analyses included heterogeneous studies. The included studies differed especially in the type of surgical procedure, the diagnosis of SSIs and the technical skills of the surgeons …”

“…66,68,73,78,80 Despite these positive outcomes, the previous meta-analysis of Patel et al showed no evidence in reducing SSIs by the use of high inspired perioperative in abdominal surgery. 86 Also, in the meta-analysis of Klingel et al, no evidence is found that administration of high inspired oxygen would reduce the risk of SSIs in women undergoing cesarean section. 87 Schietroma et al investigated the effect of 80% inspired oxygen compared to 30% inspired oxygen perioperatively on the incidence of SSI in 81 patients undergoing elective colorectal surgery for rectal cancer.…”