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Perioperative Supplemental Oxygen Reduces the Risk of Surgical Site Infection in Colorectal Surgery: a Meta-Analysis
Varun Chakravorty*1, Ronald S. Chamberlain1, 2
1Surgery, St. Barnabas Medical Center, West Orange, NJ; 2Surgery, New Jersey Medical School, Newark, NJ
Introduction: Despite advances in surgical technique and perioperative care, surgical site infection (SSI) remains one of the most common nosocomial infections in surgical patients. Post-operative patients are routinely placed on supplemental oxygen in the PACU to maintain adequate oxygen saturation and are monitored by pulse oximetry. While oxygen has been shown to play a vital role in oxidative killing of pathogenic bacteria by neutrophils, whether hyperoxia can further decrease SSI rates remains controversial. Multiple randomized controlled trials (RCT) and previous meta-analyses on this topic have failed to reach a consensus. This meta-analysis analyzes all existing RCTs involving major general and gynecologic surgery in an effort to determine whether the perioperative delivery of supernormal concentrations of supplemental oxygen can effect SSI rates.
Method: A comprehensive search of PubMed, Google Scholar, and the Cochrane and NIH registry of clinical trials was performed. RCTs assessing the impact of perioperative supplemental oxygen (high and low concentrations) following major general and gynecologic surgery on SSI rates were included. High concentrations were defined as > to a fractional inspired oxygen (FiO2) of 80%, while low concentration supplemental oxygen was a FiO2 of 30%. Subgroup analysis was performed for elective colorectal resections.
Results: 15 trials involving 7,574 patients were included in the meta-analysis. No significant difference in SSI risk between patients that received high FiO2 supplemental oxygen compared to low FiO2 was observed in the entire cohort (RR 0.883, CI 0.722-1.081, p=0.227). Four trials involved 910 patients specifically undergoing elective colorectal resections. Among these RCTs, patients receiving high FiO2 supplemental oxygen had a 44.4% reduction in SSI rate compared to the low FiO2 group (RR 0.556, CI 0.394-0.785, p=0.001).
Conclusion: Supernormal FiO2 supplementation in the immediate post-operative period did not demonstrate a significant benefit in regards to reducing SSI rate for the entire cohort including all major general and gynecologic surgery. When supernormal FiO2 supplementation was provided specifically to colorectal patients, a 44.4% reduction in the SSI risk was observed. High FiO2 supplementation to colorectal patients in the immediate post-operative period is a simple, inexpensive, and safe intervention which may improve SSI rates following elective colorectal cases, and should be considered in all patients. Additional studies are needed to better determine which colorectal patients (laparoscopic vs. open; right vs. left vs. pelvic) are most likely to benefit from perioperative high inspired oxygen supplementation.
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