Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery: The PROXI Randomized Clinical Trial

CONTEXT Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined. OBJECTIVE To assess whether use of 80% oxygen reduces the...

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Published in:	JAMA : the journal of the American Medical Association Vol. 302; no. 14; pp. 1543 - 1550
Main Authors:	Meyhoff, Christian S, Wetterslev, Jørn, Jorgensen, Lars N, Henneberg, Steen W, Høgdall, Claus, Lundvall, Lene, Svendsen, Poul-Erik, Mollerup, Hannah, Lunn, Troels H, Simonsen, Inger, Martinsen, Kristian R, Pulawska, Therese, Bundgaard, Lars, Bugge, Lasse, Hansen, Egon G, Riber, Claus, Gocht-Jensen, Peter, Walker, Line R, Bendtsen, Asger, Johansson, Gun, Skovgaard, Nina, Heltø, Kim, Poukinski, Andrei, Korshin, André, Walli, Aqil, Bulut, Mustafa, Carlsson, Palle S, Rodt, Svein A, Lundbech, Liselotte B, Rask, Henrik, Buch, Niels, Perdawid, Sharafaden K, Reza, Joan, Jensen, Kirsten V, Carlsen, Charlotte G, Jensen, Frank S, Rasmussen, Lars S, PROXI Trial Group, for the
Format:	Journal Article
Language:	English
Published:	Chicago, IL American Medical Association 14-10-2009
Subjects:	Abdominal surgery Adult Aged Aged, 80 and over Biological and medical sciences Clinical trials Female General aspects Human infectious diseases. Experimental studies and models Humans Infectious diseases Intraoperative Period Laparotomy Male Medical sciences Middle Aged Oxygen - administration & dosage Oxygen Inhalation Therapy Perioperative Care Pneumonia - epidemiology Postoperative Complications - epidemiology Postoperative Period Pulmonary Atelectasis - epidemiology Respiratory Insufficiency - epidemiology Risk Surgical Wound Infection - epidemiology Surgical Wound Infection - prevention & control High Medicine Surgical wound Nosocomial infection Perioperative Oxygen Lung Complication Clinical trial Respiratory system
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Summary:	CONTEXT Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined. OBJECTIVE To assess whether use of 80% oxygen reduces the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery. DESIGN, SETTING, AND PATIENTS The PROXI trial, a patient- and observer-blinded randomized clinical trial conducted in 14 Danish hospitals between October 2006 and October 2008 among 1400 patients undergoing acute or elective laparotomy. INTERVENTIONS Patients were randomly assigned to receive either 80% or 30% oxygen during and for 2 hours after surgery. MAIN OUTCOME MEASURES Surgical site infection within 14 days, defined according to the Centers for Disease Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory failure in 38 (5.5%) vs 31 (4.4%) (OR, 1.27; 95% CI, 0.78-2.07; P = .34), and mortality within 30 days in 30 (4.4%) vs 20 (2.9%) (OR, 1.56; 95% CI, 0.88-2.77; P = .13). CONCLUSION Administration of 80% oxygen compared with 30% oxygen did not result in a difference in risk of surgical site infection after abdominal surgery. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00364741
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ISSN:	0098-7484 1538-3598
DOI:	10.1001/jama.2009.1452