This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Evidence-Based Medicine  • Colorectal Surgery  • Surgical Infections  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

A Meta-analysis of Randomized Controlled Trials

Motaz Qadan, MBChB, MRCS(Edin); Ozan Akça, MD; Suhal S. Mahid, MRCS, PhD; Carlton A. Hornung, MPH, PhD; Hiram C. Polk Jr, MD

Arch Surg. 2009;144(4):359-366.

Objective  To conduct a meta-analysis of randomized controlled trials in which high inspired oxygen concentrations were compared with standard concentrations to assess the effect on the development of surgical site infections (SSIs).

Data Sources  A systematic literature search was conducted using the MEDLINE, EMBASE, and Cochrane databases and included a manual search of references of original articles, poster presentations, and abstracts from major meetings ("gray" literature).

Study Selection  Twenty-one of 2167 articles met the inclusion criteria. Of these, 5 randomized controlled trials (3001 patients) assessed the effect of perioperative supplemental oxygen use on the SSI rate. Studies used a treatment-inspired oxygen concentration of 80%. Maximum follow-up was 30 days.

Data Extraction  Data were abstracted by 3 independent reviewers using a standardized data collection form. Relative risks were reported using a fixed-effects model. Results were subjected to publication bias testing and sensitivity analyses.

Data Synthesis  Infection rates were 12.0% in the control group and 9.0% in the hyperoxic group, with relative risk reduction of 25.3% (95% confidence interval [CI], 8.1%-40.1%) and absolute risk reduction of 3.0% (1.1%-5.3%). The overall risk ratio was 0.742 (95% CI, 0.599-0.919; P = .006). The benefit from increasing oxygen concentration was greater in colorectal-specific procedures, with a risk ratio of 0.556 (95% CI, 0.383-0.808; P = .002).

Conclusions  Perioperative supplemental oxygen therapy exerts a significant beneficial effect in the prevention of SSIs. We recommend its use along with maintenance of normothermia, meticulous glycemic control, and preservation of intravascular volume perioperatively in the prevention of SSIs.

Author Affiliations: Department of Surgery, Price Institute of Surgical Research (Drs Qadan and Mahid), and Departments of Anesthesiology and Perioperative Medicine (Dr Akça), Epidemiology and Population Health (Dr Hornung), and Surgery (Dr Polk), University of Louisville School of Medicine, Louisville, Kentucky; and Outcomes Research Consortium, Louisville (Dr Akça).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Perioperative Supplemental Oxygen Therapy and Surgical Site Infection—Invited Critique
Lena M. Napolitano
Arch Surg. 2009;144(4):366-367.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery: The PROXI Randomized Clinical Trial
Meyhoff et al.
JAMA 2009;302:1543-1550.
ABSTRACT | FULL TEXT  

High Inspired Oxygen Fraction and Surgical Site Infection
Hunt and Hopf
JAMA 2009;302:1588-1589.
FULL TEXT