Effects of supplemental oxygen and dexamethasone on surgical site infection: A factorial randomized trial

British Journal of Anaesthesia

Volumn 115, Issue 3, 2015, Pages 434-443

  Kurz, A ^a   Fleischmann, E ^b   Sessler, D I ^a   Buggy, D J ^c   Apfel, C ^d   Akca O ^e  

^a LERNER RESEARCH INSTITUTE   (United States)

^b MEDICAL UNIVERSITY OF VIENNA   (Austria)

^c MATER MISERICORDIAE UNIVERSITY HOSPITAL   (Ireland)

^d Sagemedic Inc   (United States)

^e University of Louisville School of Medicine   (United States)

Author keywords

anaesthesia; complications; dexamethasone; infection; oxygen; postoperative infection; random allocation; steroids; surgery

Indexed keywords

DESFLURANE; DEXAMETHASONE; FENTANYL; PLACEBO; PROPOFOL; ROCURONIUM; SEVOFLURANE; VECURONIUM; ANTIEMETIC AGENT; OXYGEN;

ACUTE KIDNEY FAILURE; ADULT; ANASTOMOSIS LEAKAGE; ANESTHESIA INDUCTION; ARTICLE; ARTIFICIAL VENTILATION; BODY MASS; CLINICAL EVALUATION; COLORECTAL SURGERY; CONTROLLED STUDY; ELECTROLYTE DISTURBANCE; FACTORIAL ANALYSIS; FEMALE; HOSPITAL READMISSION; HUMAN; ILEUS; INFECTION RISK; LOW DRUG DOSE; MAJOR CLINICAL STUDY; MALE; NAUSEA AND VOMITING; OXYGEN CONCENTRATION; OXYGEN THERAPY; PERIOPERATIVE PERIOD; PHYSICIAN; PNEUMONIA; POSITIVE END EXPIRATORY PRESSURE; POSTOPERATIVE PERIOD; PRIORITY JOURNAL; PROPHYLAXIS; PUBLIC HEALTH SERVICE; RANDOMIZED CONTROLLED TRIAL; RISK REDUCTION; SEPSIS; SINGLE BLIND PROCEDURE; SINGLE DRUG DOSE; SMOKING; SURGICAL INFECTION; SURGICAL MORTALITY; SURGICAL WOUND; TIDAL VOLUME; TISSUE OXYGENATION; WOUND DEHISCENCE; CLINICAL TRIAL; INCIDENCE; MIDDLE AGED; MULTICENTER STUDY; POSTOPERATIVE COMPLICATIONS; SURGICAL WOUND INFECTION;

ANTIEMETICS; COLORECTAL SURGERY; DEXAMETHASONE; FEMALE; HUMANS; INCIDENCE; MALE; MIDDLE AGED; OXYGEN; POSTOPERATIVE COMPLICATIONS; SURGICAL WOUND INFECTION;

EID: 84942246706     PISSN: 00070912     EISSN: 14716771     Source Type: Journal    
DOI: 10.1093/bja/aev062     Document Type: Article

References (43)

1. Akca O, Kurz A, Fleischmann E, et al. Hypercapnia and surgical site infection: a randomized trial. Br J Anaesth 2013; 111: 759-67
2. Greif R, Akcą O, Horn E-P, Kurz A, Sessler DI, Outcomes Research ™ Group. Supplemental perioperative oxygen to reduce the incidence of surgical wound infection. N Engl J Med 2000; 342: 161-7
3. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334: 1209-15
4. Olsen MA, Chu-Ongsakul S, Brandt KE, Dietz JR, Mayfield J, Fraser VJ. Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg 2008; 143: 53-60
5. Qadan M, Battista C, Gardner SA, Anderson G, Akca O, Polk HC Jr. Oxygen and surgical site infection: a study of underlying immunologic mechanisms. Anesthesiology 2010; 113: 369-77
6. Allen DB, Maguire JJ, Mahdavian M, et al.Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg 1997; 132: 991-6
7. Babior BM. Oxygen-dependent microbial killing by phagocytes (second of two parts). N Engl J Med 1978; 298: 721-5
8. Babior BM. Oxygen-dependent microbial killing by phagocytes (first of two parts). N Engl J Med 1978; 298: 659-68
9. Hopf HW, Hunt TK, West JM, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 1997; 132: 997-1004
10. Chang N, Goodson WH 3rd, Gottrup F, Hunt TK. Direct measurement of wound and tissue oxygen tension in postoperative patients. Ann Surg 1983; 197: 470-8
11. Knighton DR, Halliday B, Hunt TK. Oxygen as an antibiotic. The effect of inspired oxygen on infection. Arch Surg 1984; 119: 199-204
12. Govinda R, Kasuya Y, Bala E, et al. Early postoperative subcutaneous tissue oxygen predicts surgical site infection. Anesth Analg 2010; 111: 946-52
13. Akcą O, Doufas A, Morioka N, Iscoe S, Fisher J, Sessler D. Hypercapnia improves tissue oxygenation. Anesthesiology 2002; 97: 801-6
14. Akcą O, Melischek M, Scheck T, et al. Postoperative pain and subcutaneous oxygen tension. Lancet 1999; 354: 41-2
15. Arkilic CF, Taguchi A, Sharma N, et al. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 2003; 133: 49-55
16. Fleischmann E, Herbst F, Kugener A, et al. Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80% inspired oxygen during abdominal surgery. Anesthesiology 2006; 104: 944-9
17. Akcą O, Liem E, Suleman M-I, Doufas A, Galandiuk S, Sessler D. The effect of intraoperative end-tidal carbon dioxide partial pressure on tissue oxygenation. Anaesthesia 2003; 58: 536-42
18. Treschan TA, Taguchi A, Ali SZ, et al. The effects of epidural and general anesthesia on tissue oxygenation. Anesth Analg 2003; 96: 1553-7
19. Belda FJ, Aguilera L, Garcia de la Asuncion J, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA 2005; 294: 2035-42
20. Meyhoff CS, Wetterslev J, Jorgensen LN, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA 2009; 302: 1543-50
21. Pryor KO, Fahey TJ 3rd, Lien CA, Goldstein PA. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA 2004; 291: 79-87
22. Duggal N, Poddatoori V, Noroozkhani S, Siddik-Ahmad RI, Caughey AB. Perioperative oxygen supplementation and surgical site infection after cesarean delivery: a randomized trial. Obstet Gynecol 2013; 122: 79-84
23. Williams NL, Glover MM, Crisp C, Acton AL, McKenna DS. Randomized controlled trial of the effect of 30% versus 80% fraction of inspired oxygen on cesarean delivery surgical site infection. Am J Perinatol 2013; 30: 781-6
24. Thibon P, Borgey F, Boutreux S, Hanouz JL, Le Coutour X, Parienti JJ. Effect of perioperative oxygen supplementation on 30-day surgical site infection rate in abdominal, gynecologic, and breast surgery: the ISO2 randomized controlled trial. Anesthesiology 2012; 117: 504-11
25. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 2006; 244: 758-63
26. Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF. Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007; 204: 1178-87
27. Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350: 2441-51
28. Corcoran TB, Truyens EB, Ng A, Moseley N, Doyle AC, Margetts L. Anti-emetic dexamethasone and postoperative infection risk: a retrospective cohort study. Anaesth Intensive Care 2010; 38: 654-60
29. DahlRM,Wetterslev J, JorgensenLN,Rasmussen LS,MollerAM, Meyhoff CS. The association of perioperative dexamethasone, smoking and alcohol abuse with wound complications after laparotomy. Acta Anaesthesiol Scand 2014; 58: 352-61
30. Percival VG, Riddell J, Corcoran TB. Single dose dexamethasone for postoperative nausea and vomiting-a matched case-control study of postoperative infection risk. Anaesth Intensive Care 2010; 38: 661-6
31. Eberhart LH, Holdorf S, Albert US, et al. Impact of a single perioperative dose of dexamethasone on the incidence of surgical site infections: a case-control study. J Obstet Gynaecol Res 2011; 37: 1807-12
32. Bolac CS,Wallace AH, Broadwater G, Havrilesky LJ, Habib AS. The impact of postoperative nausea and vomiting prophylaxis with dexamethasone on postoperative wound complications in patients undergoing laparotomy for endometrial cancer. Anesth Analg 2013; 116: 1041-7
33. Slessarev M, Somogyi R, Preiss D, Vesely A, Sasano H, Fisher JA. Efficiency of oxygen administration: sequential gas delivery versus 'flow into a cone' methods. Crit Care Med 2006; 34: 829-34
34. Rahbari NN, Zimmermann JB, Schmidt T, Koch M, Weigand MA, Weitz J. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br J Surg 2009; 96: 331-41
35. Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985; 121: 206-15
36. Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991; 91: S152-7
37. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: amodification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13: 606-8
38. Byrne DJ, Malek MM, Davey PG, Cuschieri A. Postoperative wound scoring. Biomed Pharmacother 1989; 43: 669-73
39. Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med 2013; 369: 428-37
40. Gottrup F, Firmin R, Rabkin J, Halliday BJ, Hunt TK. Directly measured tissue oxygen tension and arterial oxygen tension assess tissue perfusion. Crit Care Med 1987; 15: 1030-6
41. Jonsson K, Jensen JA, Goodson WH 3rd, West JM, Hunt TK. Assessment of perfusion in postoperative patients using tissue oxygen measurements. Br J Surg 1987; 74: 263-7
42. Hager H, Reddy D, Mandadi G, et al. Hypercapnia improves tissue oxygenation in morbidly obese surgical patients. Anesth Analg 2006; 103: 677-81
43. Sorensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg 2012; 255: 1069-79