Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial

Christian S Meyhoff; Jørn Wetterslev; Lars N Jorgensen; Steen W Henneberg; Claus Høgdall; Lene Lundvall; Poul-Erik Svendsen; Hannah Mollerup; Troels H Lunn; Inger Simonsen; Kristian R Martinsen; Therese Pulawska; Lars Bundgaard; Lasse Bugge; Egon G Hansen; Claus Riber; Peter Gocht-Jensen; Line R Walker; Asger Bendtsen; Gun Johansson; Nina Skovgaard; Kim Heltø; Andrei Poukinski; André Korshin; Aqil Walli; Mustafa Bulut; Palle S Carlsson; Svein A Rodt; Liselotte B Lundbech; Henrik Rask; Niels Buch; Sharafaden K Perdawid; Joan Reza; Kirsten V Jensen; Charlotte G Carlsen; Frank S Jensen; Lars S Rasmussen; PROXI Trial Group; Sharaf Perdawood

doi:10.1001/jama.2009.1452

Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial

Christian S Meyhoff, Jørn Wetterslev, Lars N Jorgensen, Steen W Henneberg, Claus Høgdall, Lene Lundvall, Poul-Erik Svendsen, Hannah Mollerup, Troels H Lunn, Inger Simonsen, Kristian R Martinsen, Therese Pulawska, Lars Bundgaard, Lasse Bugge, Egon G Hansen, Claus Riber, Peter Gocht-Jensen, Line R Walker, Asger Bendtsen, Gun JohanssonNina Skovgaard, Kim Heltø, Andrei Poukinski, André Korshin, Aqil Walli, Mustafa Bulut, Palle S Carlsson, Svein A Rodt, Liselotte B Lundbech, Henrik Rask, Niels Buch, Sharafaden K Perdawid, Joan Reza, Kirsten V Jensen, Charlotte G Carlsen, Frank S Jensen, Lars S Rasmussen, PROXI Trial Group, Sharaf Perdawood

Department of Clinical Medicine

262 Citations (Scopus)

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.

Original language	English
Journal	JAMA - Journal of the American Medical Association
Volume	302
Issue number	14
Pages (from-to)	1543-50
Number of pages	8
ISSN	0098-7484
DOIs	https://doi.org/10.1001/jama.2009.1452
Publication status	Published - 14 Oct 2009

Keywords

Adult
Aged
Aged, 80 and over
Female
Humans
Intraoperative Period
Laparotomy
Male
Middle Aged
Oxygen
Oxygen Inhalation Therapy
Perioperative Care
Pneumonia
Postoperative Complications
Postoperative Period
Pulmonary Atelectasis
Respiratory Insufficiency
Risk
Surgical Wound Infection

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10.1001/jama.2009.1452

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Meyhoff, C. S., Wetterslev, J., Jorgensen, L. N., Henneberg, S. W., Høgdall, C., Lundvall, L., Svendsen, P-E., Mollerup, H., Lunn, T. H., Simonsen, I., Martinsen, K. R., Pulawska, T., Bundgaard, L., Bugge, L., Hansen, E. G., Riber, C., Gocht-Jensen, P., Walker, L. R., Bendtsen, A., ... Perdawood, S. (2009). Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA - Journal of the American Medical Association, 302(14), 1543-50. https://doi.org/10.1001/jama.2009.1452

Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery : the PROXI randomized clinical trial. / Meyhoff, Christian S; Wetterslev, Jørn; Jorgensen, Lars N et al.

In: JAMA - Journal of the American Medical Association, Vol. 302, No. 14, 14.10.2009, p. 1543-50.

Research output: Contribution to journal › Journal article › Research › peer-review

Meyhoff, CS, Wetterslev, J, Jorgensen, LN, Henneberg, SW, Høgdall, C, Lundvall, L, Svendsen, P-E, Mollerup, H, Lunn, TH, Simonsen, I, Martinsen, KR, Pulawska, T, Bundgaard, L, Bugge, L, Hansen, EG, Riber, C, Gocht-Jensen, P, Walker, LR, Bendtsen, A, Johansson, G, Skovgaard, N, Heltø, K, Poukinski, A, Korshin, A, Walli, A, Bulut, M, Carlsson, PS, Rodt, SA, Lundbech, LB, Rask, H, Buch, N, Perdawid, SK, Reza, J, Jensen, KV, Carlsen, CG, Jensen, FS, Rasmussen, LS, PROXI Trial Group & Perdawood, S 2009, 'Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial', JAMA - Journal of the American Medical Association, vol. 302, no. 14, pp. 1543-50. https://doi.org/10.1001/jama.2009.1452

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title = "Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial",

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.",

keywords = "Adult, Aged, Aged, 80 and over, Female, Humans, Intraoperative Period, Laparotomy, Male, Middle Aged, Oxygen, Oxygen Inhalation Therapy, Perioperative Care, Pneumonia, Postoperative Complications, Postoperative Period, Pulmonary Atelectasis, Respiratory Insufficiency, Risk, Surgical Wound Infection",

author = "Meyhoff, {Christian S} and J{\o}rn Wetterslev and Jorgensen, {Lars N} and Henneberg, {Steen W} and Claus H{\o}gdall and Lene Lundvall and Poul-Erik Svendsen and Hannah Mollerup and Lunn, {Troels H} and Inger Simonsen and Martinsen, {Kristian R} and Therese Pulawska and Lars Bundgaard and Lasse Bugge and Hansen, {Egon G} and Claus Riber and Peter Gocht-Jensen and Walker, {Line R} and Asger Bendtsen and Gun Johansson and Nina Skovgaard and Kim Helt{\o} and Andrei Poukinski and Andr{\'e} Korshin and Aqil Walli and Mustafa Bulut and Carlsson, {Palle S} and Rodt, {Svein A} and Lundbech, {Liselotte B} and Henrik Rask and Niels Buch and Perdawid, {Sharafaden K} and Joan Reza and Jensen, {Kirsten V} and Carlsen, {Charlotte G} and Jensen, {Frank S} and Rasmussen, {Lars S} and {PROXI Trial Group} and Sharaf Perdawood",

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day = "14",

doi = "10.1001/jama.2009.1452",

language = "English",

volume = "302",

pages = "1543--50",

journal = "J A M A: The Journal of the American Medical Association",

issn = "0098-7484",

publisher = "American Medical Association",

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TY - JOUR

T1 - Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery

T2 - the PROXI randomized clinical trial

AU - Meyhoff, Christian S

AU - Wetterslev, Jørn

AU - Jorgensen, Lars N

AU - Henneberg, Steen W

AU - Høgdall, Claus

AU - Lundvall, Lene

AU - Svendsen, Poul-Erik

AU - Mollerup, Hannah

AU - Lunn, Troels H

AU - Simonsen, Inger

AU - Martinsen, Kristian R

AU - Pulawska, Therese

AU - Bundgaard, Lars

AU - Bugge, Lasse

AU - Hansen, Egon G

AU - Riber, Claus

AU - Gocht-Jensen, Peter

AU - Walker, Line R

AU - Bendtsen, Asger

AU - Johansson, Gun

AU - Skovgaard, Nina

AU - Heltø, Kim

AU - Poukinski, Andrei

AU - Korshin, André

AU - Walli, Aqil

AU - Bulut, Mustafa

AU - Carlsson, Palle S

AU - Rodt, Svein A

AU - Lundbech, Liselotte B

AU - Rask, Henrik

AU - Buch, Niels

AU - Perdawid, Sharafaden K

AU - Reza, Joan

AU - Jensen, Kirsten V

AU - Carlsen, Charlotte G

AU - Jensen, Frank S

AU - Rasmussen, Lars S

AU - PROXI Trial Group

AU - Perdawood, Sharaf

PY - 2009/10/14

Y1 - 2009/10/14

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Humans

KW - Intraoperative Period

KW - Laparotomy

KW - Male

KW - Middle Aged

KW - Oxygen

KW - Oxygen Inhalation Therapy

KW - Perioperative Care

KW - Pneumonia

KW - Postoperative Complications

KW - Postoperative Period

KW - Pulmonary Atelectasis

KW - Respiratory Insufficiency

KW - Risk

KW - Surgical Wound Infection

U2 - 10.1001/jama.2009.1452

DO - 10.1001/jama.2009.1452

M3 - Journal article

C2 - 19826023

SN - 0098-7484

VL - 302

SP - 1543

EP - 1550

JO - J A M A: The Journal of the American Medical Association

JF - J A M A: The Journal of the American Medical Association

IS - 14

ER -

Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial

Abstract

Keywords

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