O2 No Longer the Go2: A Systematic Review and Meta-Analysis Comparing the Effects of Giving Perioperative Oxygen Therapy of 30% FiO2 to 80% FiO2 on Surgical Site Infection and Mortality

  • Brianna K. SmithEmail author
  • Ross H. Roberts
  • Frank A. Frizelle
Scientific Review



To determine the effects of perioperative high (80%) versus low (30%) fraction of inspired oxygen (FiO2) on surgical site infection (SSI) and mortality in adult surgical patients.


The routine use of high fraction perioperative oxygen in patients is “standard of care” and recommended by the World Health Organisation; however, whether there is truly any benefit to this therapy has been challenged by some authors. Questions have also been raised about the possibility of harm from oxygen therapy.


Randomised control trials comparing high-to-low FiO2 were located by searching MEDLINE, Embase, CENTRAL and Web of Science. The primary outcomes were SSI up to 15 days and up to any time point postoperatively and mortality up to 30 days. The data were analysed using random effects meta-analysis.


Twelve studies involving 10,212 participants were included. At 15 days postoperatively, and at the longest point of post-operative follow-up, there was no statistically significant reduction in the risk of SSI when comparing patients who received a perioperative FiO2 of 30% to those with an FiO2 of 80% (RR 1.41, 95% CI 1.00–2.01, p 0.05 and RR 1.23, 95% CI 1.00–1.51, p 0.05). There was no statistically significant difference in mortality between the 30% FiO2 and the 80% FiO2 groups (RR 1.12, 95% CI 0.56–2.22, p 0.76).


This meta-analysis showed no statistically significant difference in post-operative SSI or mortality when comparing patients receiving an FiO2 of 80% to those receiving an FiO2 of 30%.



The authors thank Professor Suetonia C Palmer, Nephrologist at Christchurch Public Hospital and Professor at the University of Otago Christchurch—for her assistance in performing the statistical analysis. The authors also thank Dr Andrew M McCombie, Postdoctoral Fellow at the University of Otago Christchurch—for guidance on developing the review.


No funding sources to disclose.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Supplementary material

268_2019_5224_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)


  1. 1.
    Pilcher J, Beasley R (2015) Acute use of oxygen therapy. Aust Prescr 38(3):98–100CrossRefGoogle Scholar
  2. 2.
    (2018) Global guidelines for the prevention of surgical site infection, 2nd edn. World Health Organization, Geneva, pp 110–114Google Scholar
  3. 3.
    Greif R, Akça O, Horn E-P et al (2000) Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 342(3):161–167CrossRefGoogle Scholar
  4. 4.
    Wetterslev J, Meyhoff CS, Jørgensen LN et al (2015) The effects of high perioperative inspiratory oxygen fraction for adult surgical patients. Cochrane Database Syst Rev. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Meyhoff CS, Jorgensen LN, Wetterslev J et al (2012) Increased long-term mortality after a high perioperative inspiratory oxygen fraction during abdominal surgery: follow-up of a randomized clinical trial. Anesth Analg 115(4):849–854CrossRefGoogle Scholar
  6. 6.
    Habre W, Peták F (2014) Perioperative use of oxygen: variabilities across age. Br J Anaesth 113:ii26–ii36CrossRefGoogle Scholar
  7. 7.
    Fonnes S, Gogenur I, Sondergaard ES et al (2016) Perioperative hyperoxia: long-term impact on cardiovascular complications after abdominal surgery, a post hoc analysis of the PROXI trial. Int J Cardiol 215:238–243CrossRefGoogle Scholar
  8. 8.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRefGoogle Scholar
  9. 9.
    Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions: the cochrane collaboration (updated 2011 March; cited 2018 October). Version 5.1.0.
  10. 10.
    Fariba F, Loghman G, Daem R et al (2016) Effect of supplemental oxygen on the incidence and severity of wound infection after cesarean surgery. J Chem Pharm Sci 9(4):3320–3325Google Scholar
  11. 11.
    Bickel A, Gurevits M, Vamos R et al (2011) Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis a randomized, prospective, controlled trial. Arch Surg 146(4):464–470CrossRefGoogle Scholar
  12. 12.
    Turtiainen J, Saimanen EI, Partio TJ et al (2011) Supplemental postoperative oxygen in the prevention of surgical wound infection after lower limb vascular surgery: a randomized controlled trial. World J Surg 35(6):1387–1395. CrossRefPubMedGoogle Scholar
  13. 13.
    Thibon P, Borgey F, Boutreux S et al (2012) Effect of perioperative oxygen supplementation on 30-day surgical site infection rate in abdominal, gynecologic, and breast surgery the ISO2 randomized controlled trial. Anesthesiology 117(3):504–511CrossRefGoogle Scholar
  14. 14.
    Pryor K, Fahey T, Lien C et al (2004) Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population. JAMA 291(1):79–87CrossRefGoogle Scholar
  15. 15.
    Lobo MAS, Salgado FP, Castillo GTV et al (2000) Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med 28(10):3396–3404CrossRefGoogle Scholar
  16. 16.
    Podolyak IA, Sessler JD, Reiterer JC et al (2016) Perioperative supplemental oxygen does not worsen long-term mortality of colorectal surgery patients. Anesth Analg 122(6):1907–1911CrossRefGoogle Scholar
  17. 17.
    Meyhoff CS, Wetterslev J, Jorgensen LN et al (2009) Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery the PROXI randomized clinical trial. JAMA-J Am Med Assoc 302(14):1543–1550CrossRefGoogle Scholar
  18. 18.
    Kurz A, Fleischmann E, Sessler DI et al (2015) Effects of supplemental oxygen and dexamethasone on surgical site infection: a factorial randomized trial. Br J Anaesth 115(3):434–443CrossRefGoogle Scholar
  19. 19.
    Williams NL, Glover MM, Crisp C et al (2013) Randomized controlled trial of the effect of 30% versus 80% fraction of inspired oxygen on cesarean delivery surgical site infection. Am J Perinatol 30(9):781–786CrossRefGoogle Scholar
  20. 20.
    Kurz A, Kopyeva T, Suliman I et al (2018) Supplemental oxygen and surgical-site infections: an alternating intervention controlled trial. Br J Anaesth 120(1):117–126CrossRefGoogle Scholar
  21. 21.
    Schietroma M, Cecilia EM, De Santis G et al (2016) Supplemental peri-operative oxygen and incision site infection after surgery for perforated peptic ulcer: a randomized, double-blind monocentric trial. Surg Infect 17(1):106CrossRefGoogle Scholar
  22. 22.
    Schietroma M, Pessia B, Colozzi S et al (2016) Effect of high perioperative oxygen fraction on surgical site infection following surgery for acute sigmoid diverticulitis. a prospective, randomized, double blind, controlled, monocentric trial. Chirurgia 111(3):242–250 (Bucharest, Romania: 1990) PubMedGoogle Scholar
  23. 23.
    Mayzler O, Weksler N, Domchik S et al (2005) Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery? Minerva Anestesiol 71(1–2):21–25PubMedGoogle Scholar
  24. 24.
    Gardella C, Bartholomew L, Laschansky E et al (2008) High-concentration supplemental perioperative oxygen to reduce the incidence of postcesarean surgical site infection: a randomized controlled trial. Obstet Gynecol 112(3):545–552CrossRefGoogle Scholar
  25. 25.
    Belda FJ, Aguilera L, de la Asuncion JG et al (2005) Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA-J Am Med Assoc 294(16):2035–2042CrossRefGoogle Scholar
  26. 26.
    Duggal IN, Poddatorri BV, Noroozkhani BS et al (2013) Perioperative oxygen supplementation and surgical site infection after cesarean delivery: a randomized trial. Obstet Gynecol 122(1):79–84CrossRefGoogle Scholar
  27. 27.
    Stall A, Paryavi E, Gupta R et al (2013) Perioperative supplemental oxygen to reduce surgical site infection after open fixation of high-risk fractures: a randomized controlled pilot trial. J Trauma Acute Care Surg 75(4):657–663CrossRefGoogle Scholar
  28. 28.
    Cohen B, Schacham YN, Ruetzler K et al (2018) Effect of intraoperative hyperoxia on the incidence of surgical site infections: a meta-analysis. Br J Anaesth 120(6):1176–1186CrossRefGoogle Scholar
  29. 29.
    Mattishent K, Thavarajah M, Sinha A et al (2019) Safety of 80% vs 30–35% fraction of inspired oxygen in patients undergoing surgery: a systematic review and meta-analysis. Br J Anaesth 122(3):311–324CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Christchurch Public HospitalCanterbury District Health BoardChristchurchNew Zealand
  2. 2.Department of General Surgery at Christchurch Public HospitalCanterbury District Health BoardChristchurchNew Zealand
  3. 3.University of Otago ChristchurchChristchurchNew Zealand

Personalised recommendations