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

JAMA. 2009 Oct 14;302(14):1543-50. doi: 10.1001/jama.2009.1452.

Abstract

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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Intraoperative Period
  • Laparotomy*
  • Male
  • 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*

Substances

  • Oxygen

Associated data

  • ClinicalTrials.gov/NCT00364741