Effect of Perioperative Supplemental Oxygen Administration on Surgical Site Infection in Patients Underwent Abdominal Surgery with General Anesthesia: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHAOPan , ZHANGYong-qiang , GUOHai , ZHENGHong ,  WANGJiang

Department of Anesthesiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

WANGJiang, Email: 710985359@qq.com

Keywords：

Supplemental oxygen; Surgical site infection; Abdominal surgery; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160067

Video：

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Objective To systematically review the effect of perioperative supplemental oxygen administration on surgical site infection (SSI) in patients underwent abdominal surgery with general anesthesia. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 2,2015), CBM, VIP, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) about perioperative supplemental oxygen administration versus normal FiO₂ in patients underwent abdominal surgery with general anesthesia from inception to March, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using RevMan 5.3 software. Results A total of 13 RCTs involving 3 532 patients were included. The results of meta-analysis indicated that: the incidence of SSI in the perioperative supplemental oxygen administration group was lower than that in the control group (OR=0.68, 95%CI 0.47 to 0.99, P=0.04). There were no significiant differences between both groups in incidence of atelectasis, incidence of infection requiring reoperation and 30-day mortality after surgery (all P values >0.05). Conclusion Perioperative supplemental oxygen administration could further decrease the risk of SSI in patients underwent abdominal surgery with general anesthesia, and does not increase the risk of other adverse events. Due to the limitations of quality of included studies, more high quality studies are needed to verify the above conclusions.

Citation： ZHAOPan, ZHANGYong-qiang, GUOHai, ZHENGHong, WANGJiang. Effect of Perioperative Supplemental Oxygen Administration on Surgical Site Infection in Patients Underwent Abdominal Surgery with General Anesthesia: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(4): 435-441. doi: 10.7507/1672-2531.20160067 Copy

1.	Coello R, Charlett A, Wilson J, et al. Adverse impact of surgical site infections in English hospitals. J Hosp Infect, 2005, 60(2):93-103.
2.	Young PY, Khadaroo RG. Surgical site infections. Surg Clin N Am, 2014, 94(6):1245-1264.
3.	Bremmelgaard A, Raahave D, Beier-Holgersen R, et al. Computer-aided surveillance of surgical infections and identification of risk factors. J Hosp Infect, 1989, 13(1):1-18.
4.	Classen DC, Evans RS, Pestotnik SL, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med, 1992, 326(5):281-286.
5.	Akça O, Melischek M, Scheck T, et al. Postoperative pain and subcutaneous oxygen tension. Lancet, 1999, 354(9172):41-42.
6.	Habre W, Petak F. Perioperative use of oxygen:variabilities across age. British Journal of Anaesthesia, 2014, 113(S2):ii26-36.
7.	Barone JE, Tucker JB, Cecere J, et al. Hypothermia does not result in more complications after colon surgery. Am Surg, 1999, 65(4):356-359.
8.	Hopf HW, Holm J. Hyperoxia and infection. Best Pract Res Clin Anaesthesiol, 2008, 22(3):553-569.
9.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at:www.cochrane-handbook.org.
10.	Akca O, Podolsky A, Eisenhuber E, et al. Comparable postoperative pulmonary atelectasis in patients given 30% or 80% oxygen during and 2 hours after colon resection. Anesthesiology, 1999, 91(4):991-998.
11.	Belda FJ, Aguilera L, José García de la Asunción, et al. Supplemental perioperative oxygen and the risk of surgical wound infection:a randomized controlled trial. JAMA, 2005, 294(16):2035-2042.
12.	Bickel A, Gurevits M, Vamos R, et al. Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis:a randomized, prospective, controlled trial. Arch Surg, 2011, 146(4):464-470.
13.	Greif R, Laciny S, Rapf B. Supplemental Oxygen Reduces the Incidence of Postoperative Nausea and Vomiting. Anesthesiology, 1999, 91(5):1246-1252.
14.	Greif R, Akca O, Horn EP, et al. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med, 2000, 342(3):161-167.
15.	Mayzler O, Weksler N, Domchik S, et al. Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery? Minerva Anesthesiol, 2005, 71(1-2):21-25.
16.	Meyhoff CS, Wetterslev J, Jorgensen LN, 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.
17.	Myles PS, Leslie K, Chan MT, et al. Avoidance of nitrous oxide for patients undergoing major surgery:a randomized controlled trial. Anesthesiology, 2007, 107(2):221-231.
18.	Pryor KO, Fahey TJ, Lien CA, et al. 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.
19.	Sadrolsadat SH, Shoroghi M, Farahbakhsh F, et al. The effect of supplemental 70% oxygen on postoperative nausea and vomiting in patients undergoing inguinal hernia surgery. Hernia, 2008, 12(2):167-171.
20.	Schietroma M, Marina E, Carlei F, et al. Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration:a prospective randomized, double-blind, controlled, single-center trial. Ann Surg Oncol, 2013, 20(5):1584-1590.
21.	Schietroma M, Cecilia EM, Sista F, et al. 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):719-726.
22.	Staehr AK, Meyhoff CS, Henneberg SW, et al. Influence of perioperative oxygen fraction on pulmonary function after abdominal surgery:a randomized controlled trial. BMC Res Notes, 2012, 5:383.
23.	Allen DB, Maguire JJ, Mahdavian M, et al. Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg, 1997, 132(9):991-996.
24.	Hopf HW, Hunt TK, West JM, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg, 1997, 132(9):997-1004.
25.	Munoz-Price LS, Sands L, Lubarsky DA. Effect of high perioperative oxygen supplementation on surgical site infections. Clin Infect Dis, 2013, 57(10):1465-1472.
26.	Knighton DR, Halliday B, Hunt TK. Oxygen as an antibiotic. A comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance. Arch Surg, 1986, 121(2):191-195.
27.	Edmark L, Kostova-Aherdan K, Enlund M, et al. Optimal oxygen concentration during induction of general anesthesia. Anesthesiology, 2003, 98(1):28-33.

1. Coello R, Charlett A, Wilson J, et al. Adverse impact of surgical site infections in English hospitals. J Hosp Infect, 2005, 60(2):93-103.
2. Young PY, Khadaroo RG. Surgical site infections. Surg Clin N Am, 2014, 94(6):1245-1264.
3. Bremmelgaard A, Raahave D, Beier-Holgersen R, et al. Computer-aided surveillance of surgical infections and identification of risk factors. J Hosp Infect, 1989, 13(1):1-18.
4. Classen DC, Evans RS, Pestotnik SL, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med, 1992, 326(5):281-286.
5. Akça O, Melischek M, Scheck T, et al. Postoperative pain and subcutaneous oxygen tension. Lancet, 1999, 354(9172):41-42.
6. Habre W, Petak F. Perioperative use of oxygen:variabilities across age. British Journal of Anaesthesia, 2014, 113(S2):ii26-36.
7. Barone JE, Tucker JB, Cecere J, et al. Hypothermia does not result in more complications after colon surgery. Am Surg, 1999, 65(4):356-359.
8. Hopf HW, Holm J. Hyperoxia and infection. Best Pract Res Clin Anaesthesiol, 2008, 22(3):553-569.
9. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at:www.cochrane-handbook.org.
10. Akca O, Podolsky A, Eisenhuber E, et al. Comparable postoperative pulmonary atelectasis in patients given 30% or 80% oxygen during and 2 hours after colon resection. Anesthesiology, 1999, 91(4):991-998.
11. Belda FJ, Aguilera L, José García de la Asunción, et al. Supplemental perioperative oxygen and the risk of surgical wound infection:a randomized controlled trial. JAMA, 2005, 294(16):2035-2042.
12. Bickel A, Gurevits M, Vamos R, et al. Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis:a randomized, prospective, controlled trial. Arch Surg, 2011, 146(4):464-470.
13. Greif R, Laciny S, Rapf B. Supplemental Oxygen Reduces the Incidence of Postoperative Nausea and Vomiting. Anesthesiology, 1999, 91(5):1246-1252.
14. Greif R, Akca O, Horn EP, et al. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med, 2000, 342(3):161-167.
15. Mayzler O, Weksler N, Domchik S, et al. Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery? Minerva Anesthesiol, 2005, 71(1-2):21-25.
16. Meyhoff CS, Wetterslev J, Jorgensen LN, 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.
17. Myles PS, Leslie K, Chan MT, et al. Avoidance of nitrous oxide for patients undergoing major surgery:a randomized controlled trial. Anesthesiology, 2007, 107(2):221-231.
18. Pryor KO, Fahey TJ, Lien CA, et al. 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.
19. Sadrolsadat SH, Shoroghi M, Farahbakhsh F, et al. The effect of supplemental 70% oxygen on postoperative nausea and vomiting in patients undergoing inguinal hernia surgery. Hernia, 2008, 12(2):167-171.
20. Schietroma M, Marina E, Carlei F, et al. Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration:a prospective randomized, double-blind, controlled, single-center trial. Ann Surg Oncol, 2013, 20(5):1584-1590.
21. Schietroma M, Cecilia EM, Sista F, et al. 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):719-726.
22. Staehr AK, Meyhoff CS, Henneberg SW, et al. Influence of perioperative oxygen fraction on pulmonary function after abdominal surgery:a randomized controlled trial. BMC Res Notes, 2012, 5:383.
23. Allen DB, Maguire JJ, Mahdavian M, et al. Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg, 1997, 132(9):991-996.
24. Hopf HW, Hunt TK, West JM, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg, 1997, 132(9):997-1004.
25. Munoz-Price LS, Sands L, Lubarsky DA. Effect of high perioperative oxygen supplementation on surgical site infections. Clin Infect Dis, 2013, 57(10):1465-1472.
26. Knighton DR, Halliday B, Hunt TK. Oxygen as an antibiotic. A comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance. Arch Surg, 1986, 121(2):191-195.
27. Edmark L, Kostova-Aherdan K, Enlund M, et al. Optimal oxygen concentration during induction of general anesthesia. Anesthesiology, 2003, 98(1):28-33.

Chinese Journal of Evidence-Based Medicine

Effect of Perioperative Supplemental Oxygen Administration on Surgical Site Infection in Patients Underwent Abdominal Surgery with General Anesthesia: A Meta-analysis

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