Key result
Intraoperative fraction of inspired oxygen was not associated with days alive and out of hospital at 90 days (adjusted mean difference for low vs high FiO2 0.28 days; 95% CI -0.05 to 0.62; P=0.2).
Why the study?
There is limited knowledge regarding the effect of liberal intraoperative oxygen on non-infectious complications and overall recovery after surgery.
Does the intraoperative fraction of inspired oxygen affect days alive and out of hospital at 90 days in adults undergoing elective surgery?
Cohort (n=15,449)
No
Does the intraoperative fraction of inspired oxygen affect days alive and out of hospital at 90 days in adults undergoing elective surgery?
Mean Difference: 0.28 (95% CI -0.05–0.62)
p-value: p=0.2
Liberal intraoperative oxygen administration does not significantly affect days alive and out of hospital at 90 days, but may be associated with increased respiratory complications and ICU admissions, while low oxygen may increase surgical site infections.
Background There is limited knowledge about the effect of liberal intraoperative oxygen on non-infectious complications and overall recovery from surgery. Methods In this retrospective cohort study, we investigated associations between mean intraoperative fraction of inspired oxygen (FiO 2 ), and outcome in adults undergoing elective surgery lasting more than 2 h at a large metropolitan New Zealand hospital from 2012 to 2020. Patients were divided into low, medium, and high oxygen groups (FiO 2 ≤ 0.4, 0.41–0.59, ≥0.6). The primary outcome was days alive and out of hospital at 90 days (DAOH 90 ). The secondary outcomes were post-operative complications and admission to the ICU. Results We identified 15,449 patients who met the inclusion criteria. There was no association between FiO 2 and DAOH 90 when high FiO 2 was analysed according to three groups. Using high FiO 2 as the reference group there was an adjusted mean (95% confidence interval [CI]) difference of 0.09 (−0.06 to 0.25) days ( P = 0.25) and 0.28 (−0.05 to 0.62) days ( P = 0.2) in the intermediate and low oxygen groups, respectively. Low FiO 2 was associated with increased surgical site infection: the adjusted odds ratio (OR) for low compared with high FiO 2 was 1.53 (95% CI 1.12–2.10). Increasing FiO 2 was associated with respiratory complications: the adjusted OR associated with each 10% point increase in FiO 2 was 1.17 (95% CI 1.08–1.26) and the incidence of being admitted to an ICU had an adjusted OR of 1.1 (95% CI 1.03–1.18). Conclusions We found potential benefits, and risks, associated with liberal intraoperative oxygen administration indicating that randomised controlled trials are warranted.
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Frei et al. (2024) conducted a cohort in elective surgery lasting more than 2 h (n=15,449). Intraoperative fraction of inspired oxygen (FiO2) vs. High FiO2 (≥0.6) was evaluated on days alive and out of hospital at 90 days (DAOH90) (MD 0.28, 95% CI -0.05 to 0.62, p=0.2). Intraoperative fraction of inspired oxygen was not associated with days alive and out of hospital at 90 days (adjusted mean difference for low vs high FiO2 0.28 days; 95% CI -0.05 to 0.62; P=0.2).
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