Skip to main content

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

World Journal of Surgery volume 44, pages 69–77 (2020)Cite this article

Abstract

Objective

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.

Background

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.

Method

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.

Results

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).

Conclusion

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%.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

References

  1. Pilcher J, Beasley R (2015) Acute use of oxygen therapy. Aust Prescr 38(3):98–100

    Article  Google Scholar 

  2. (2018) Global guidelines for the prevention of surgical site infection, 2nd edn. World Health Organization, Geneva, pp 110–114

  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):161–167

    CAS  Article  Google Scholar 

  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. https://doi.org/10.1002/14651858.CD008884.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  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):849–854

    Article  Google Scholar 

  6. Habre W, Peták F (2014) Perioperative use of oxygen: variabilities across age. Br J Anaesth 113:ii26–ii36

    Article  Google Scholar 

  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 215:238–243

    Article  Google Scholar 

  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):e1000097

    Article  Google Scholar 

  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. http://handbook-5-1.cochrane.org/

  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):3320–3325

    CAS  Google Scholar 

  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):464–470

    Article  Google Scholar 

  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. https://doi.org/10.1007/s00268-011-1090-y

    Article  PubMed  Google Scholar 

  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):504–511

    CAS  Article  Google Scholar 

  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):79–87

    CAS  Article  Google Scholar 

  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):3396–3404

    CAS  Article  Google Scholar 

  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):1907–1911

    CAS  Article  Google Scholar 

  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):1543–1550

    CAS  Article  Google Scholar 

  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):434–443

    CAS  Article  Google Scholar 

  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):781–786

    Article  Google Scholar 

  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):117–126

    CAS  Article  Google Scholar 

  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):106

    Article  Google Scholar 

  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)

    PubMed  Google Scholar 

  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):21–25

    CAS  PubMed  Google Scholar 

  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):545–552

    Article  Google Scholar 

  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):2035–2042

    CAS  Article  Google Scholar 

  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):79–84

    Article  Google Scholar 

  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):657–663

    CAS  Article  Google Scholar 

  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):1176–1186

    CAS  Article  Google Scholar 

  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):311–324

    Article  Google Scholar 

Download references

Acknowledgements

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.

Funding

No funding sources to disclose.

Author information

Affiliations

  1. Christchurch Public Hospital, Canterbury District Health Board, 2 Riccarton Ave, Christchurch Central, Christchurch, 8011, New Zealand

    Brianna K. Smith

  2. Department of General Surgery at Christchurch Public Hospital, Canterbury District Health Board, Christchurch, New Zealand

    Ross H. Roberts & Frank A. Frizelle

  3. University of Otago Christchurch, Christchurch, New Zealand

    Ross H. Roberts & Frank A. Frizelle

Authors
  1. Brianna K. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ross H. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frank A. Frizelle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brianna K. Smith.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Smith, B.K., Roberts, R.H. & Frizelle, F.A. 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. World J Surg 44, 69–77 (2020). https://doi.org/10.1007/s00268-019-05224-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05224-3