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Review
. 2013 Aug;56(4):E82-90.
doi: 10.1503/cjs.001012.

High-concentration oxygen and surgical site infections in abdominal surgery: a meta-analysis

Sunil V Patel  1 , Shaun C Coughlin, Richard A Malthaner
Affiliations
Review

High-concentration oxygen and surgical site infections in abdominal surgery: a meta-analysis

Sunil V Patel et al. Can J Surg. 2013 Aug.

Abstract
in English, French

Background: There has been recent interest in using high-concentration oxygen to prevent surgical site infections (SSIs). Previous meta-analyses in this area have produced conflicting results. With the publication of 2 new randomized controlled trials (RCTs) that were not included in previous meta-analyses, an updated review is warranted. Our objective was to perform a meta-analysis on RCTs comparing high- and low- concentration oxygen in adults undergoing open abdominal surgery.

Methods: We completed independent literature reviews using electronic databases, bibliographies and other sources of grey literature to identify relevant studies. We assessed the overall quality of evidence using grade guidelines. Statistical analysis was performed on pooled data from included studies. A priori subgroup analyses were planned to explain statistical and clinical heterogeneity.

Results: Overall, 6 studies involving a total of 2585 patients met the inclusion criteria. There was no evidence of a reduction in SSIs with high-concentration oxygen (risk ratio 0.77, 95% confidence interval 0.50-1.19, p = 0.24). We observed substantial heterogeneity among studies.

Conclusion: There is moderate evidence that high-concentration oxygen does not reduce SSIs in adults undergoing open abdominal surgery.

Contexte: On observe depuis peu un intérêt à l'endroit de l'oxygène à concentration élevée pour prévenir les infections de plaies opératoires. Les méta-analyses réalisées dans le passé à ce sujet ont donné des résultats divergents. Compte tenu de la publication de 2 nouveaux essais randomisés et contrôlés (ERC) qui n'ont pas été inclus dans les méta-analyses précédentes, une nouvelle revue de la situation s'imposait. Notre objectif était donc d'effectuer une méta-analyse des ERC, qui ont comparé l'oxygène à concentration élevée et faible chez des adultes soumis à une chirurgie abdominale ouverte.

Méthodes: Nous avons effectué des analyses indépendantes de la littérature à partir de bases de données électroniques, de bibliographies et autres éléments de la littérature « grise » pour identifier les études pertinentes. Nous avons classé la qualité glo - bale des données probantes selon les lignes directrices de catégorisation. L'analyse statistique a porté sur les données regroupées des études incluses. Des analyses de sous-groupes ont été planifiées a priori pour expliquer l'hétérogénéité statistique et clinique.

Résultants: En tout, 6 études regroupant 2585 patients répondaient aux critères d'inclusion. On n'a noté aucune preuve de réduction des infections de plaies opératoires associées à l'oxygène à concentration élevée (risque relatif 0,77, intervalle de confiance de 95 % 0,50–1,19, p = 0,24). Nous avons observé une forte hétérogénéité entre les études.

Conclusions: On dispose de données probantes acceptables selon lesquelles l'oxygène à concentration élevée ne réduit pas les infections de plaies opératoires chez les adultes soumis à une chirurgie abdominale ouverte.

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Figures

Fig. 1
Fig. 1
Literature search results.
Fig. 2
Fig. 2
Risk of surgical site infection in high-concentration and low-concentration oxygen groups (pooled risk ratio [RR] 0.77, 95% confidence interval [CI] 0.50–1.19, p = 0.24).
Fig. 3
Fig. 3
Subgroup analysis of patients who had elective colorectal surgery (rest of subgroup interaction p = 0.16). CI = confidence interval; RR = risk ratio.
Fig. 4
Fig. 4
Subgroup analysis excluding the study with unclear risk of bias (test of subgroup interaction p = 0.003). CI = confidence interval; RR = risk ratio.
Fig. 5
Fig. 5
Subgroup analysis including studies with standardized prophylactic antibiotic use (test of subgroup interaction p = 0.69). CI = confidence interval; RR = risk ratio.
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Comment in

References

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