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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

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%.

Notes

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.

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)

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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

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