Role of Supplemental Oxygen in Perioperative Period for Reducing Surgical Site Infection: A Comparative Hospital Based Study

Abstract

Aashaq Hussain, Wasim Raja and Azher Mushtaq*

Introduction: Sepsis has been regarded as an insult to the surgeon and surgeons are always in search of methods of reducing and minimising the occurrence of post-surgical infection and sepsis. There are various factors, which predispose to SSI including host factors and environmental factors. The host-derived factors which contribute importantly to the risk of SSI, include, age, obesity, malnutrition, diabetes mellitus, hypocholesterolemia, immunocompromised states, hypoalbumenemia and several other factors not accounted for by National Nosocomial Infections Surveillance (NNIS) System. Intraoperative hypothermia is also associated with an increased incidence of SSIs following many operations. We performed a study to evaluate the role of perioperative orthobaric supplemental oxygen therapy (high FIO2) in preventing the occurrence of surgical Site Infections (SSIs). Materials and methods: A total of 100 patients were included in the study. Patients were divided into two groups alternately with 50 patients in each group. Both the groups were matched in age, sex and type of surgery. One group (Study group) was subjected to peri-operative oxygen supplementation (high FIO2; 60% oxygen) and the other group (Control group) was subjected to (30% oxygen) perioperatively. The patients in the study group received 60% fraction of inspired oxygen intra-operatively and 2 hours post operatively, the other group received room air post operatively. Patients of both groups were observed for the occurrence of wound infection. The wound infection was diagnosed clinically by the presence of clinical signs including local induration, erythema, tenderness, warmth, wound discharge, crepitus etc. described by the Centers for Disease Control Recommendations to Prevent Surgical Site Infections. Observations: In our study, in a total of 100 patients, 50 belonged to control group and 50 to study group. The male female ratio was 26:24 in control group and 28:22 in study group respectively. The mean age of patients in our study was 39.52 ± 11.55 years, while as the mean age in study group was 39.8 ± 11.18 years and in control group was 39.27 ± 12.02 years. In our study, the Mean BMI of patients in the Study Group was 21.7 ± 9.2 and the mean BMI of the Control Group was 23.7 ± 8.6. The difference was however statistically insignificant. P-Value being 0.78. In our study we observed that the infection rate in the study group who received 60% fraction of inspired oxygen perioperatively was 20%, i.e 10 out of 50 patients developed surgical site infections while as in control group who received 30% fractions of inspired oxygen perioperatively, 36% of patients i.e 18 out of 50 (control group) patients developed surgical site infections. The difference between the two groups was statistically significant with p value of 0.043676. Conclusion: we concluded that the use of hyperoxygenation throughout the surgical interventions in different elective surgeries has a major effect on the frequency of SSI without an increase in the frequency of adverse effects.