Background Destruction by oxidation, or oxidative killing, isthe most important defense against surgical pathogens and dependson the partial pressure of oxygen in contaminated tissue. Aneasy method of improving oxygen tension in adequately perfusedtissue is to increase the concentration of inspired oxygen.We therefore tested the hypothesis that the supplemental administrationof oxygen during the perioperative period decreases the incidenceof wound infection.
Methods We randomly assigned 500 patients undergoing colorectalresection to receive 30 percent or 80 percent inspired oxygenduring the operation and for two hours afterward. Anesthetictreatment was standardized, and all patients received prophylacticantibiotic therapy. With use of a double-blind protocol, woundswere evaluated daily until the patient was discharged and thenat a clinic visit two weeks after surgery. We considered woundswith culture-positive pus to be infected. The timing of sutureremoval and the date of discharge were determined by the surgeon,who did not know the patient's treatment-group assignment.
Results Arterial oxygen saturation was normal in both groups;however, the arterial and subcutaneous partial pressure of oxygenwas significantly higher in the patients given 80 percent oxygenthan in those given 30 percent oxygen. Among the 250 patientswho received 80 percent oxygen, 13 (5.2 percent; 95 percentconfidence interval, 2.4 to 8.0 percent) had surgical-woundinfections, as compared with 28 of the 250 patients given 30percent oxygen (11.2 percent; 95 percent confidence interval,7.3 to 15.1 percent; P=0.01). The absolute difference betweengroups was 6.0 percent (95 percent confidence interval, 1.2to 10.8 percent). The duration of hospitalization was similarin the two groups.
Conclusions The perioperative administration of supplementaloxygen is a practical method of reducing the incidence of surgical-woundinfections.
Source Information
From the Department of Anesthesiology and Intensive Care Medicine, Donauspital (R.G.); the Department of Anesthesia and General Intensive Care, Vienna General Hospital, University of Vienna (O.A., A.K., D.I.S.);and the Ludwig Boltzmann Institute for Clinical Anesthesia (D.I.S.) — all in Vienna, Austria; the Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany (E.-P.H.); the Department of Anesthesiology, Washington University, St. Louis (A.K.); and the Department of Anesthesia and Perioperative Care, University of California–San Francisco, San Francisco (D.I.S.).
Address reprint requests to Dr. Sessler at the Outcomes Research Group, Department of Anesthesia, 374 Parnassus Ave., Third Fl., University of California–San Francisco, San Francisco, CA 94143-0648, or at sessler{at}anesthesia.ucsf.edu.
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