Does Perioperative Oxygen Reduce Surgical Wound Infections?

Albert B. Lowenfels, MD


July 15, 2009

Perioperative Supplemental Oxygen Therapy and Surgical Site Infection: A Meta-Analysis of Randomized Controlled Trials

Qadan M, Akça O, Mahid SS, Hornung CA, Polk HC Jr
Arch Surg. 2009;144:359-366


Does perioperative oxygen reduce surgical wound infections? The authors carried out a meta-analysis based on 5 randomized controlled trials discovered after searching > 2000 reports. Of these 5 studies, 3 included only patients undergoing colorectal surgery. Oxygen concentration was 80% in the therapeutic group compared with 30% to 35% in the control group. Duration of postoperative oxygen supplementation was 2 to 6 hours. Use of supplemental oxygen therapy lowered the wound infection rate from 12% to 9% (P = .006).


As pointed out in an accompanying editorial,[1] this study provides some evidence for a beneficial effect of oxygen. However, there were considerable differences and weaknesses within each of the included studies. For example, some of the data on wound infection was collected from retrospective chart review, rather than prospectively. Also, the length of wound observation for infection varied in the studies. Recognized evidenced-based measures that are known to reduce wound infection rates include appropriate preoperative antibiotic administration, avoidance of hypothermia, proper skin prep, etc. Although supplemental oxygen therapy may prove to be beneficial, a large, carefully conducted trial is needed to determine its true benefit.