Journal of Gastrointestinal Surgery

, Volume 23, Issue 1, pp 145–152 | Cite as

Effect of Perioperative High Oxygen Concentration on Postoperative SSI in Elective Colorectal Surgery—A Randomized Controlled Trial

  • Mangal Mayank
  • Subair Mohsina
  • Sathasivam Sureshkumar
  • Pankaj Kundra
  • Vikram KateEmail author
2018 SSAT Plenary Presentation



This study was carried out to investigate the effect of perioperative high oxygen concentration on surgical site infection (SSI) in patients undergoing elective colorectal surgery.


This was a single-center, prospective, parallel arm, double-blind, superiority randomized controlled trial. All patients more than 18 years of age undergoing elective colorectal surgery were included as per the inclusion criteria. Patients were randomized at the time of induction of anesthesia into high concentration and standard concentration oxygen group based on the concentration of oxygen. Incidence of SSI, day of the detection of SSI, grade of SSI, incidence of anastomotic leak, postoperative day of return of bowel functions, day of starting oral feeds, day of ambulation, and length of hospitalization were studied in both the groups.


A total of 94 patients were included in the study, 47 patients each in high concentration oxygen group and standard concentration oxygen group respectively. The SSI rates were comparable between the two groups [55.3% (95% CI—4.012–69.83) vs. 40.4% (95% CI—26.37–55.73); p = 0.215]. There was no significant difference found with respect to mean day of detection of SSI [4.5(IQR—3.0–7.5) vs. 6.0 (IQR—3.0–9.0; p = 0.602], postoperative day of return of bowel functions (2.20 ± 0.542 vs. 2.13 ± 0.582; p = 0.540), oral feeds (3.62 ± 0.945 vs. 3.46 ± 1.048; p = 0.544), ambulation (4.17 ± 0.868 vs. 4.17 ± 1.270; p = 0.987), and the length of hospitalization [15(IQR—10–19) vs. 15(IQR—10.75–18.25); p = 0.862] between the two groups.


There was no significant difference in the rate of SSI with the use of perioperative high oxygen concentration in patients undergoing elective colorectal surgery.


SSI Non-rebreathing mask Colon surgery Rectal surgery Perioperative period 



The authors acknowledge the support of the Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER, Pondicherry, India) towards the conduct of the study.

Authors’ Contributions

All the authors were involved in the acquisition and analysis of the data. Dr. Vikram Kate contributed towards the conception of the work and also revised the manuscript critically for intellectual content. Dr. Mangal Mayank was the principal investigator and contributed towards acquisition and analysis of data and preparation of the manuscript. Dr. Subair Mohsina, Dr. S. Sureshkumar, and Dr. Pankaj Kundra contributed towards analysis of data and preparation of the manuscript and its critical evaluation.


No grants/funds used for this research project.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Schietroma M, Cecilia EM, Sista F, Carlei F, Pessia B, Amicucci G. High-concentration supplemental perioperative oxygen and surgical site infection following elective colorectal surgery for rectal cancer: a prospective, randomized, double-blind, controlled, single-site trial. Am J Surg 2014;208(5):719–26.CrossRefGoogle Scholar
  2. 2.
    Hedrick TL, Sawyer RG, Friel CM, Stukenborg GJ. A Method for Estimating the Risk of Surgical Site Infection in Patients With Abdominal Colorectal Procedures: Dis Colon Rectum 2013;56(5):627–37.Google Scholar
  3. 3.
    Nichols RL. Preventing surgical site infections: a surgeon’s perspective. Emerg Infect Dis 2001;7(2):220–4.CrossRefGoogle Scholar
  4. 4.
    Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, et al. Wound Infection After Elective Colorectal Resection: Ann Surg 2004;239(5):599–607.Google Scholar
  5. 5.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Committee HICPA, et al. Guideline for prevention of surgical site infection, 1999. Am J Infect Control 1999;27(2):97–134.CrossRefGoogle Scholar
  6. 6.
    Hunt TK, Hopf HW. High Inspired Oxygen Fraction and Surgical Site Infection. JAMA 2009;302(14):1588–9.CrossRefGoogle Scholar
  7. 7.
    Pryor KO, Fahey TJ, Lien CA, Goldstein PA. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA 2004;291(1):79–87.CrossRefGoogle Scholar
  8. 8.
    Greif R, Akça O, Horn E-P, Kurz A, Sessler DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 2000;342(3):161–167.CrossRefGoogle Scholar
  9. 9.
    Belda FJ, Aguilera L, de la Asunción JG, Alberti J, Vicente R, Ferrándiz L, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. Jama 2005;294(16):2035–2042.CrossRefGoogle Scholar
  10. 10.
    Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Høgdall C, Lundvall L, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. Jama 2009;302(14):1543–1550.CrossRefGoogle Scholar
  11. 11.
    Wilson APR, Sturridge MF, Treasure T, Grüneberg RN. A scoring method (ASEPSIS) for postoperative wound infections for use in clinical trials of antibiotic prophylaxis. The Lancet 1986;327(8476):311–312.CrossRefGoogle Scholar
  12. 12.
    Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC Definitions of Nosocomial Surgical Site Infections, 1992: A Modification of CDC Definitions of Surgical Wound Infections. Infect Control Hosp Epidemiol 1992;13(10):606–8.CrossRefGoogle Scholar
  13. 13.
    Thibon P, Borgey F, Boutreux S, Hanouz J-L, Le Coutour X, Parienti J-J. Effect of perioperative oxygen supplementation on 30-day surgical site infection rate in abdominal, gynecologic, and breast surgery: the ISO2 randomized controlled trial. Anesthesiology 2012;117(3):504–11.Google Scholar
  14. 14.
    Myles PS, Leslie K, Chan MTV, Forbes A, Paech MJ, Peyton P, et al. Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial. Anesthesiology 2007;107(2):221–31.CrossRefGoogle Scholar
  15. 15.
    Mayzler O, Weksler N, Domchik S, Klein M, Mizrahi S, Gurman GM. Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery?. Minerva Anestesiol 2005;71(1–2):21–5.Google Scholar
  16. 16.
    Brar MS, Brar SS, Dixon E. Perioperative Supplemental Oxygen in Colorectal Patients: A Meta-Analysis. J Surg Res 2011;166(2):227–35.CrossRefGoogle Scholar
  17. 17.
    Togioka B, Galvagno S, Sumida S, Murphy J, Ouanes J-P, Wu C. The Role of Perioperative High Inspired Oxygen Therapy in Reducing Surgical Site Infection: A Meta-Analysis. Anesth Analg 2012;114(2):334–42.CrossRefGoogle Scholar
  18. 18.
    Chura JC, Boyd A, Argenta PA. Surgical Site Infections and Supplemental Perioperative Oxygen in Colorectal Surgery Patients: A Systematic Review. Surg Infect 2007;8(4):455–62.CrossRefGoogle Scholar
  19. 19.
    Al-Niaimi A, Safdar N. Supplemental perioperative oxygen for reducing surgical site infection: a meta-analysis. J Eval Clin Pract 2009;15(2):360–5.CrossRefGoogle Scholar
  20. 20.
    Qadan M, Akça O, Mahid SS, Hornung CA, Polk HC. Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials. Arch Surg 2009;144(4):359–366.CrossRefGoogle Scholar
  21. 21.
    Wang H, Hong S, Liu Y, Duan Y, Yin H. High inspired oxygen versus low inspired oxygen for reducing surgical site infection: a meta-analysis: Hyperoxygenation and surgical site infection. Int Wound J 2017;14(1):46–52.CrossRefGoogle Scholar
  22. 22.
    Yang W, Liu Y, Zhang Y, Zhao Q-H, He S-F. Effect of intra-operative high inspired oxygen fraction on surgical site infection: a meta-analysis of randomized controlled trials. J Hosp Infect 2016;93(4):329–38.CrossRefGoogle Scholar
  23. 23.
    Ricciardi R, Roberts PL, Hall JF, Read TE, Francone TD, Pinchot SN, et al. What Is the Effect of Stoma Construction on Surgical Site Infection After Colorectal Surgery?. J Gastrointest Surg 2014;18(4):789–95.CrossRefGoogle Scholar
  24. 24.
    Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective Colon and Rectal Surgery Differ in Risk Factors for Wound Infection: Results of Prospective Surveillance. Ann Surg 2006;244(5):758–63.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Mangal Mayank
    • 1
  • Subair Mohsina
    • 1
  • Sathasivam Sureshkumar
    • 1
  • Pankaj Kundra
    • 2
  • Vikram Kate
    • 1
    Email author
  1. 1.Departments of SurgeryJawaharlal Institute of Postgraduate Medical Education and ResearchPondicherryIndia
  2. 2.Department of Anaesthesiology & Critical CareJawaharlal Institute of Postgraduate Medical Education and ResearchPondicherryIndia

Personalised recommendations