• Lillian S Kao, Stefanos G Millas, Claudia Pedroza, Jon E Tyson, and Kevin P Lally.
• Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston, TX 77026, USA. Lillian.S.Kao@uth.tmc.edu
• Ann. Surg. 2012 Dec 1; 256 (6): 894901894-901.

ObjectiveThe 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.BackgroundUse of hyperoxia to reduce SSIs is controversial. Three recent meta-analyses have had conflicting conclusions.MethodsA 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.ResultsTraditional 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.ConclusionsThere 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.

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