Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection

Background Destruction by oxidation, or oxidative killing, is the most impo rtant defense against surgical pathogens and depends on the partial pressur e of oxygen in contaminated tissue. An easy method of improving oxygen tens ion in adequately perfused tissue is to increase the concentration of inspi red oxygen. We therefore tested the hypothesis that the supplemental admini stration of oxygen during the perioperative period decreases the incidence of wound infection. Methods We randomly assigned 500 patients undergoing colorectal resection t o receive 30 percent or 80 percent inspired oxygen during the operation and for two hours afterward. Anesthetic treatment was standardized, and all pa tients received prophylactic antibiotic therapy. With use of a double-blind protocol, wounds were evaluated daily until the patient was discharged and then at a clinic visit two weeks after surgery. We considered wounds with culture-positive pus to be infected. The timing of suture removal and the d ate of discharge were determined by the surgeon, who did not know the patie nt's treatment-group assignment. Results Arterial oxygen saturation was normal in both groups; however, the arterial and subcutaneous partial pressure of oxygen was significantly high er in the patients given 80 percent oxygen than in those given 30 percent o xygen. Among the 250 patients who received 80 percent oxygen, 13 (5.2 perce nt; 95 percent confidence interval, 2.4 to 8.0 percent) had surgical-wound infections, as compared with 28 of the 250 patients given 30 percent oxygen (11.2 percent; 95 percent confidence interval, 7.3 to 15.1 percent; P=0.01 ). The absolute difference between groups was 6.0 percent (95 percent confi dence interval, 1.2 to 10.8 percent). The duration of hospitalization was s imilar in the two groups. Conclusions The perioperative administration of supplemental oxygen is a pr actical method of reducing the incidence of surgical-wound infections. (N E ngl J Med 2000;342:161-7.) (C) 2000, Massachusetts Medical Society.