Effects of supplemental oxygen and dexamethasone on surgical site infection: a factorial randomized trial‡
A Kurz, E Fleischmann, D I Sessler, D J Buggy, C Apfel, O Akça, Factorial Trial Investigators, Edith Fleischmann, Erol Erdik, Klaus Eredics, Barbara Kabon, Friedrich Herbst, Sara Kazerounian, Andre Kugener, Corinna Marschalek, Pia Mikocki, Monika Niedermayer, Eva Obewegeser, Ina Ratzenboeck, Romana Rozum, Sonja Sindhuber, Katja Schlemitz, Karl Schebesta, Anton Stift, Andrea Kurz, Daniel I Sessler, Endrit Bala, Samuel T Chen, Jagan Devarajan, Ankit Maheshwari, Ramatia Mahboobi, Edward Mascha, Hassan Nagem, Suman Rajogopalan, Luke Reynolds, Adrian Alvarez, Luca Stocchi, Anthony G Doufas, Raghavendra Govinda, Yusuke Kasuya, Ryu Komatsu, Rainer Lenhardt, Mukadder Orhan-Sungur, Papiya Sengupta, Anupama Wadhwa, Susan Galandiuk, Donal Buggy, Mujeeb Arain, Siun Burke, Barry McGuire, Jackie Ragheb, Akikio Taguchi, A Kurz, E Fleischmann, D I Sessler, D J Buggy, C Apfel, O Akça, Factorial Trial Investigators, Edith Fleischmann, Erol Erdik, Klaus Eredics, Barbara Kabon, Friedrich Herbst, Sara Kazerounian, Andre Kugener, Corinna Marschalek, Pia Mikocki, Monika Niedermayer, Eva Obewegeser, Ina Ratzenboeck, Romana Rozum, Sonja Sindhuber, Katja Schlemitz, Karl Schebesta, Anton Stift, Andrea Kurz, Daniel I Sessler, Endrit Bala, Samuel T Chen, Jagan Devarajan, Ankit Maheshwari, Ramatia Mahboobi, Edward Mascha, Hassan Nagem, Suman Rajogopalan, Luke Reynolds, Adrian Alvarez, Luca Stocchi, Anthony G Doufas, Raghavendra Govinda, Yusuke Kasuya, Ryu Komatsu, Rainer Lenhardt, Mukadder Orhan-Sungur, Papiya Sengupta, Anupama Wadhwa, Susan Galandiuk, Donal Buggy, Mujeeb Arain, Siun Burke, Barry McGuire, Jackie Ragheb, Akikio Taguchi
Abstract
Background: Tissue oxygenation is a strong predictor of surgical site infection. Improving tissue oxygenation should thus reduce wound infection risk. Supplemental inspired oxygen can improve tissue oxygenation, but whether it reduces infection risk remains controversial. Low-dose dexamethasone is often given to reduce the risk of postoperative nausea and vomiting, but steroid-induced immunosuppression can increase infection risk. We therefore tested the hypotheses that supplemental perioperative oxygen reduces infection risk and that dexamethasone increases it.
Methods: Using a factorial design, patients having colorectal resections expected to last ≥2 h were randomly assigned to 30% (n=270) or 80% (n=285) inspired oxygen during and for 1 h after surgery, and to 4 mg intraoperative dexamethasone (n=283) or placebo (n=272). Physicians blinded to group assignments evaluated wounds postoperatively, using US Centers for Disease Control criteria.
Results: Subject and surgical characteristics were similar among study groups. Surgical site infection incidence was similar among groups: 30% oxygen 15.6%, 80% oxygen 15.8% (P=1.00); dexamethasone 15.9%, placebo 15.4%, (P=0.91).
Conclusions: Supplemental oxygen did not reduce surgical site infection risk. The preponderance of clinical evidence suggests that administration of 80% supplemental inspired oxygen does not reduce infection risk. We did not observe an increased risk of surgical site infection with the use of a single low dose of dexamethasone, indicating that it can be used for nausea and vomiting prophylaxis without promoting wound infections.
Clinical trial registration: ClinicalTrials.gov number: NCT00273377.
Keywords: anaesthesia; oxygen; postoperative infection; random allocation; steroids, dexamethasone; surgery, complications, infection.
© The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Source: PubMed