Peri-operative oxygen and the risk of surgical infection.

BACKGROUND: In spite of all efforts, surgical site infection (SSI) continues to be a common and costly complication of surgical procedures and thus a major concern for surgeons, patients, and hospitals. Laboratory observations that high concentrations of oxygen in tissues enhance bacterial killing and improve wound healing have prompted the study of peri-operative oxygenation as a means of reducing SSI.

METHODS: Review of pertinent English-language literature.

RESULTS: Seven randomized, controlled studies of increased peri-operative oxygenation during and shortly after general anesthesia have been conducted since 2000, with four showing no benefit (including one terminated early because of possible harmful effects) and three showing positive effects, with risk reductions of 25%-50%. Three meta-analyses also have been conducted and concluded that there likely is a beneficial effect of increased peri-operative oxygenation.

CONCLUSIONS: Given the divergent results of this relatively large number of randomized studies, no definitive consensus has emerged. At present, clinicians should proceed with caution, and the administration of greater amounts of supplemental oxygen probably should be restricted to well-designed and -conducted clinical trials.