title: Supplemental Peri-Operative Oxygen and Incision Site Infection after Surgery for Perforated Peptic Ulcer: A Randomized, Double-Blind Monocentric Trial.
abstract: BACKGROUND
  The clinical role of hyperoxia for preventing surgical site infection (SSI) remains uncertain because randomized controlled trials on this topic have reported disparate results. One of the principal reasons for this outcome may be that prior trials have entered heterogeneous populations of patients and a variety of procedures. The aim of our study was to assess the influence of hyperoxygenation on SSI using a homogeneous study population.
  
  
  METHODS
  From January 2004 to April 2013, we studied, in a randomized trial, 239 patients, who underwent open surgery for perforated peptic ulcer (PPU). The surgical procedure was performed through an upper abdominal midline incision, and closure of PPU was achieved by suture alone or in combination with an omental patch. Patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 120) or 80% (n = 119). Administration was commenced after induction of anesthesia and maintained for 6 hours after surgery.
  
  
  RESULTS
  The overall incision infection rate was 38.4% (92 of 239): 61 patients (50.8%) had an infection in the 30% FiO2 group and 31 (26%) in the 80% FiO2 group (p < 0.05). The risk of SSI was 48% lower in the 80% FiO2 group (relative risk 0.51; 95% confidence interval [CI] 0.28-1.08) vs 30% FiO2.
  
  
  CONCLUSIONS
  Supplemental 80% FiO2 during and for 6 h after open surgery for PPU, which reduces post-operative SSI, should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost.
authors.affiliation: Department of Surgery, University of L'Aquila , Coppito, Italy .
authors.forename: Mario
authors.initials: M
authors.lastname: Schietroma
authors.affiliation: Department of Surgery, University of L'Aquila , Coppito, Italy .
authors.forename: Emanuela Marina
authors.initials: EM
authors.lastname: Cecilia
authors.affiliation: Department of Surgery, University of L'Aquila , Coppito, Italy .
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Santis
authors.affiliation: Department of Surgery, University of L'Aquila , Coppito, Italy .
authors.forename: Francesco
authors.initials: F
authors.lastname: Carlei
authors.affiliation: Department of Surgery, University of L'Aquila , Coppito, Italy .
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pessia
authors.affiliation: Department of Surgery, University of L'Aquila , Coppito, Italy .
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amicucci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage*; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen