Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial.
BACKGROUND
Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined.


OBJECTIVE
To assess whether use of 80% oxygen reduces the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery.


METHODS
The PROXI trial, a patient- and observer-blinded randomized clinical trial conducted in 14 Danish hospitals between October 2006 and October 2008 among 1400 patients undergoing acute or elective laparotomy.


METHODS
Patients were randomly assigned to receive either 80% or 30% oxygen during and for 2 hours after surgery.


METHODS
Surgical site infection within 14 days, defined according to the Centers for Disease Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality.


RESULTS
Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory failure in 38 (5.5%) vs 31 (4.4%) (OR, 1.27; 95% CI, 0.78-2.07; P = .34), and mortality within 30 days in 30 (4.4%) vs 20 (2.9%) (OR, 1.56; 95% CI, 0.88-2.77; P = .13).


CONCLUSIONS
Administration of 80% oxygen compared with 30% oxygen did not result in a difference in risk of surgical site infection after abdominal surgery.


BACKGROUND
clinicaltrials.gov Identifier: NCT00364741.
Meyhoff
Christian S
CS
Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Wetterslev
Jørn
J
Jorgensen
Lars N
LN
Henneberg
Steen W
SW
Høgdall
Claus
C
Lundvall
Lene
L
Svendsen
Poul-Erik
PE
Mollerup
Hannah
H
Lunn
Troels H
TH
Simonsen
Inger
I
Martinsen
Kristian R
KR
Pulawska
Therese
T
Bundgaard
Lars
L
Bugge
Lasse
L
Hansen
Egon G
EG
Riber
Claus
C
Gocht-Jensen
Peter
P
Walker
Line R
LR
Bendtsen
Asger
A
Johansson
Gun
G
Skovgaard
Nina
N
Heltø
Kim
K
Poukinski
Andrei
A
Korshin
André
A
Walli
Aqil
A
Bulut
Mustafa
M
Carlsson
Palle S
PS
Rodt
Svein A
SA
Lundbech
Liselotte B
LB
Rask
Henrik
H
Buch
Niels
N
Perdawid
Sharafaden K
SK
Reza
Joan
J
Jensen
Kirsten V
KV
Carlsen
Charlotte G
CG
Jensen
Frank S
FS
Rasmussen
Lars S
LS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage; D010102:Oxygen Inhalation Therapy; D019990:Perioperative Care; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D001261:Pulmonary Atelectasis / Q000453:epidemiology*; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012306:Risk; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
D010100:Oxygen