Should perioperative supplemental oxygen be routinely recommended for surgery patients? A Bayesian meta-analysis.

Objective: The purpose of this study is to use updated data and Bayesian methods to evaluate the effectiveness of hyperoxia to reduce surgical site infections (SSIs) and/or mortality in both colorectal and all surgery patients. Because few trials assessed potential harms of hyperoxia, hazards were not included.

Background: Use of hyperoxia to reduce SSIs is controversial. Three recent meta-analyses have had conflicting conclusions.

Methods: A systematic literature search and review were performed. Traditional fixed-effect and random-effect meta-analyses and Bayesian meta-analysis were performed to evaluate SSIs and mortality.

Results: Traditional meta-analysis yielded a relative risk of an SSI with hyperoxia among all surgery patients of 0.84 [95% confidence interval (CI): 0.73-0.97] and 0.84 (95% CI: 0.61-1.16) for the fixed-effect and random-effect models, respectively. The probabilities of any risk reduction in SSIs among all surgery patients were 77%, 81%, and 83% for skeptical, neutral, and enthusiastic priors. The subset analysis of colorectal surgery patients increased the probabilities to 86%, 89%, and 92%. The probabilities of at least a 10% reduction were 57%, 62%, and 68% for all surgery patients and 71%, 75%, and 80% among the colorectal surgery subset.

Conclusions: There is a moderately high probability of a benefit to hyperoxia in reducing SSIs in colorectal surgery patients; however, the magnitude of benefit is relatively small and might not exceed treatment hazards. Further studies should focus on generalizability to other patient populations or on treatment hazards and other outcomes.