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
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.
- 2.(2018) Global guidelines for the prevention of surgical site infection, 2nd edn. World Health Organization, Geneva, pp 110–114Google 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):3320–3325Google 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) PubMedGoogle Scholar