Annals of Surgery

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Annals of Surgery:
doi: 10.1097/SLA.0b013e31826cc8da

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*,†,‖

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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.

© 2012 Lippincott Williams & Wilkins, Inc.


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