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Should Perioperative Supplemental Oxygen Be Routinely Recommended for Surgery Patients? A Bayesian Meta-Analysis

Kao, Lillian S. MD, MS*,†,‡; Millas, Stefanos G. MD; Pedroza, Claudia PhD*; Tyson, Jon E. MD, MPH*,†,§; Lally, Kevin P. MD, MS*,†,‖

doi: 10.1097/SLA.0b013e31826cc8da

Objective: The purpose of this study is to use updated data and Bayesian methods to evaluate the effectiveness of hyperoxia to reduce surgical site infections (SSIs) and/or mortality in both colorectal and all surgery patients. Because few trials assessed potential harms of hyperoxia, hazards were not included.

Background: Use of hyperoxia to reduce SSIs is controversial. Three recent meta-analyses have had conflicting conclusions.

Methods: A systematic literature search and review were performed. Traditional fixed-effect and random-effect meta-analyses and Bayesian meta-analysis were performed to evaluate SSIs and mortality.

Results: Traditional meta-analysis yielded a relative risk of an SSI with hyperoxia among all surgery patients of 0.84 [95% confidence interval (CI): 0.73–0.97] and 0.84 (95% CI: 0.61–1.16) for the fixed-effect and random-effect models, respectively. The probabilities of any risk reduction in SSIs among all surgery patients were 77%, 81%, and 83% for skeptical, neutral, and enthusiastic priors. The subset analysis of colorectal surgery patients increased the probabilities to 86%, 89%, and 92%. The probabilities of at least a 10% reduction were 57%, 62%, and 68% for all surgery patients and 71%, 75%, and 80% among the colorectal surgery subset.

Conclusions: There is a moderately high probability of a benefit to hyperoxia in reducing SSIs in colorectal surgery patients; however, the magnitude of benefit is relatively small and might not exceed treatment hazards. Further studies should focus on generalizability to other patient populations or on treatment hazards and other outcomes.

An updated meta-analysis of randomized trials comparing perioperative supplemental oxygen or hyperoxia with normal concentrations of inspired oxygen was performed using both traditional and Bayesian methods. The results are consistent with a modest reduction in surgical site infections. However, harms, including mortality, have not been adequately addressed by existing trials.

*Center for Clinical Research and Evidence-Based Medicine

Center for Surgical Trials and Evidence-Based Practice (C-STEP)

Departments of Surgery


Pediatric Surgery, The University of Texas Health Science Center at Houston, TX.

Reprints: Lillian S. Kao, MD, MS, Department of Surgery, The University of Texas Health Science Center at Houston, 5656 Kelley Street, Suite 30S 62008, Houston, TX 77026. E-mail:

Disclosure: Three authors are supported by grants from the National Institutes of Health (NIH). Dr Kao is supported by K23RR020020–03; Dr Tyson is supported by 5 U10 HD021373–26, 5KL2 RR024149–04, and 5 UL1RR024148–04; and Dr Pedroza is supported by KL2 RR024149.

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© 2012 Lippincott Williams & Wilkins, Inc.