title: The role of perioperative high inspired oxygen therapy in reducing surgical site infection: a meta-analysis.
abstract: BACKGROUND
  The clinical role of hyperoxia for preventing surgical site infection remains uncertain because randomized controlled trials on this topic have reported disparate results. Our objective in this systematic review was to determine whether perioperative hyperoxia reduces surgical site infection.
  
  
  METHODS
  An electronic search was conducted using the National Library of Medicine's MEDLINE, Cochrane Collaboration's CENTRAL, and EMBASE databases. Included studies consisted of randomized controlled trials in an adult population with a clearly defined comparison of high oxygen versus low oxygen or control, and with a documented assessment for perioperative infection. Pooled estimates for odds ratios (ORs) with 95% confidence intervals were obtained for our primary outcome (surgical site infection) using the Cochrane Collaboration's RevMan version 5.0.25 (Cochrane Collaboration, Oxford, UK). ORs were calculated using a random effects model.
  
  
  RESULTS
  The literature search ultimately yielded 7 trials, enrolling 2728 patients, that were included in the analysis. There were 1358 patients randomly assigned to hyperoxia and 1370 to control. The pooled infection rate in the hyperoxia group was 15.5% versus 17.5% in the control group. Hyperoxia resulted in an OR of 0.85 for surgical site infection (95% confidence interval: 0.52, 1.38) (P = 0.51). However, 2 subgroup analyses (general anesthesia and colorectal surgery trials) showed a benefit for high inspired oxygen therapy of decreasing surgical site infection.
  
  
  CONCLUSIONS
  Perioperative high inspired oxygen therapy overall was not found to be beneficial for preventing surgical site infection based on this meta-analysis. The positive results of 2 subgroup analyses (general anesthesia and colorectal surgery trials) suggest a benefit for hyperoxia in decreasing surgical site infection. Additional studies are needed to further investigate this intervention.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Togioka
authors.forename: Samuel
authors.initials: S
authors.lastname: Galvagno
authors.forename: Shawn
authors.initials: S
authors.lastname: Sumida
authors.forename: Jamie
authors.initials: J
authors.lastname: Murphy
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Ouanes
authors.forename: Christopher
authors.initials: C
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010102:Oxygen Inhalation Therapy; D019990:Perioperative Care; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult