High-concentration Supplemental Perioperative Oxygen to Reduce the Incidence of Postcesarean Surgical Site Infection: A Randomized Controlled Trial

Gardella, Carolyn; Goltra, L. B.; Laschansky, Ellen C.; Drolette, Linda; Magaret, Amalia; Chadwick, H. S.; Eschenbach, David A.

doi:10.1097/01.aoa.0000358393.31004.ee

Cited by 25 publications

(44 citation statements)

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“…We excluded the study by Myles and colleagues 14 because it had no standardized high-concentration oxygen group and because it included patients undergoing nonabdominal procedures. Four trials [26][27][28][29] were excluded because they assessed patients undergoing cesarean delivery.…”

Section: Summary Of Excluded Studiesmentioning

confidence: 99%

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

Patel

Coughlin²,

Malthaner³

2013

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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...

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Section: Summary Of Excluded Studiesmentioning

confidence: 99%

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

Patel

Coughlin²,

Malthaner³

2013

cjs

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“…Two other studies reported no effect of hyperoxygenation on the risk of SSI. 16,17 The single-center study carried out by Mayzler 16 on surgery for colorectal cancer had a small statistical power (only 38 patients included). The study by Gardella 17 concerned cesarean section and was stopped for reasons of futility after the inclusion of 143 patients, an interim analysis having shown a doubling of the frequency of SSI in the 80% group, indicating that continuation of the trial could not lead to the demonstration of a beneficial effect of hyperoxygenation.…”

Section: Discussionmentioning

confidence: 99%

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

Thibon

Boutreux²,

Hanouz

et al. 2012

Anesthesiology

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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-

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“…There are currently 4 randomized controlled reports of 1769 parturients randomized to receive either 80% or 30% inspired oxygen during regional anaesthesia and for 1-2 h thereafter. None of the trials from Seattle [8], St. Louis [24], San Jose [6] and Dayton [9] found that supplemental oxygen reduced infection risk. There is thus not a single trial providing any evidence supporting the recommendation to increase FiO2 during regional anaesthesia.…”

Section: Adult Patients Undergoing General Anaesthesia With Endotrachmentioning

confidence: 99%

The WHO recommendation for 80% perioperative oxygen is poorly justified

Volk

Sessler

2017

Anaesthesist

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High-concentration Supplemental Perioperative Oxygen to Reduce the Incidence of Postcesarean Surgical Site Infection: A Randomized Controlled Trial

Cited by 25 publications

References 0 publications

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

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

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

The WHO recommendation for 80% perioperative oxygen is poorly justified

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