Effect of intra-operative high inspired oxygen fraction on surgical site infection: a meta-analysis of randomized controlled trials.
BACKGROUND
Surgical site infection (SSI) causes significant mortality and morbidity. Administration of a high inspired oxygen fraction (FiO2) to patients undergoing surgery may represent a potential preventive strategy.


OBJECTIVE
To conduct a meta-analysis of randomized controlled trials in which high FiO2 was compared with normal FiO2 in patients undergoing surgery to estimate the effect on the development of SSI.


METHODS
A comprehensive search was undertaken for randomized controlled trials (until December 2015) that compared high FiO2 with normal FiO2 in adults undergoing surgery with general anaesthesia and reported on SSI.


RESULTS
This study included 17 randomized controlled trials with 8093 patients. Infection rates were 13.11% in the control group and 11.53% in the hyperoxic group, while the overall risk ratio was 0.893 [95% confidence interval (CI) 0.794-1.003; P = 0.057]. Subgroup analyses stratified by country, definition of SSI, and type of surgery were also performed, and showed similar results. However, high FiO2 was found to be of significant benefit in patients undergoing colorectal surgery, with a risk ratio of 0.735 (95% CI 0.573-0.944; P=0.016).


CONCLUSIONS
There is moderate evidence to suggest that administration of high FiO2 to patients undergoing surgery, especially colorectal surgery, reduces the risk of SSI. Further studies with better adherence to the intervention may affect the results of this meta-analysis.
Department of Anaesthesiology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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W
Yang
Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Teaching Centre for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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Y
Liu
Department of Anaesthesiology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Y
Zhang
Department of Food and Nutrition Hygiene, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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QH
Zhao
Department of Anaesthesiology, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China. Electronic address: hsf77@163.com.
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SF
He
D006801:Humans; D010100:Oxygen / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
D010100:Oxygen
Intra-operative high inspired oxygen; Meta-analysis; Randomized controlled trials; Surgical site infection