Extra oxygen aids post-op infection control
Extra oxygen aids post-op infection control
Risk-free, low-cost procedure lowers length of stay
Here’s a practice change that reduces surgical wound infections by 50%. The technique also reduces nausea and vomiting in at least half of surgical cases. Adoption of the change would probably raise few objections from any quarter "because it’s simple to implement, and the costs are trivial," says one of the discoverers of the technique, Daniel Sessler, MD, assistant vice president for Health Affairs and professor of Anesthesiology at the University of Louisville (KY).1
While the standard concentration of supplemental intraoperative oxygen is 30%, when increased to 80%, it halves the incidence of infection and nausea. The cost is about 3 cents per patient.
Sessler and fellow researchers learned from earlier studies that patients who are kept warmer during surgery suffer fewer postoperative infections. Hypothermia makes infections worse by causing constriction of blood vessels and decreasing oxygen delivery to tissues. On the strength of that evidence, they tested the hypothesis that increased oxygen could reduce the infection risk by stabilizing body temperature.
Recipients of 80% oxygen | Recipients of 30% oxygen | |
Incidence of wound infections | 5.2% | 11.2% |
Admitted to ICU | 2% | 4.8% |
They conducted a study on 500 patients undergoing colorectal resection. All patients received prophylactic antibiotic therapy; 250 received the standard 30% oxygen, and 250 received 80% oxygen. The patients were ages 18 to 80. They were undergoing elective open colorectal resection, in most cases, for cancer or inflammatory bowel disease. In the research report, Sessler and colleagues write that the incidence of wound infection in colorectal surgery patients ranges from 9% to 27%. The complications can prolong hospital stays by five to 20 days.
The results of the study were impressive, especially since there were no negative side effects. Length of stay for patients with infection was 18.7 days vs. 11.4 days for patients without infection. Smokers, who run a significant risk of surgical wound infection, showed surprising results in the study. Those in the 80% oxygen group, had no higher infection rates than nonsmoking patients. "However, an important difference between this and previous studies is that smoking is no longer allowed in patients’ rooms; furthermore, smoking areas are not even readily accessible from some wards," write the investigators.
The use of increased oxygen is gaining acceptance, according to Sessler. It is effective for other types of inpatient as well as outpatient surgeries. While he cautions that his study did not address the process of initiating increased supplemental oxygen as a practice in hospitals, "the only guidelines that would require change would be those relating to the oxygen level to administer to a patient. And that’s an anesthetic decision. Any costs and procedural changes would be trivial to implement."
Reference
1. Grief R, Akca O, Horn E, et al. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 2000: 342:161-167.
Need More Information?
For more on the use and benefits of increased supplemental oxygen during surgery, contact:
Daniel Sessler, MD, University of Louisville (KY). E-mail: [email protected].
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