A Meta Analysis of 80% Fraction of Inspired Oxygen On Surgical Site

Vol 3 No 1 April 2023 E-ISSN : 2797-0035
Solo Journal of Anesthesi, Pain and Critical Care P- ISSN : 2776-1770
REVIEW ARTICLE
A Meta-Analysis of 80% Fraction of Inspired Oxygen on Surgical Site
Infection in Patients Undergoing Surgery
Rifaldy Nabiel Erisadana*, Achmad Ilham Tohari*, Yehuda Tri Nugroho Supranoto*, Wiwien
Sugih Utami**, Laksmi Indreswari***
ABSTRACT
Article Info : Background: WHO recommended the use of 80% FiO2
Submitted : in patients undergoing general anesthesia with
19-06-2022 endotracheal intubation (ETI) to prevent surgical site
Accepted : infection (SSI). However, the ongoing debate regarding
21-03-2023 efficacy and safety raises because further trials have been
Published : published. We conducted a review based on
31-04-2023
recommendations in terms of SSI as the primary outcome
https://doi.org/10.20961/ and adverse events as the secondary outcome in both
soja.V3i1.62251 patients with or without ETI.
Method: A literature search was carried out by PubMed,
ScienceDirect, and Google Scholar for RCTs in all-type
Authors’ affiliations: surgical patients who administrated 80% FiO2 compared
*
Faculty of Medicine, with 30–35% FiO2. Pooled relative risks with a 95%
Universitas Jember, confidence interval were conducted for meta-analysis.
Result: Based on 23 RCTs included in the analysis, there
Indonesia
** were no significant differences in terms of SSI (RR,0.85;
Department of
95%CI, 0.72 to 1.01; p=0.07), sepsis (RR,1.47; 95%CI,
Parasitology, Faculty of
0.78 to 2.76; p=0.23), postoperative hospitalization days
Medicine, Universitas (PHD) (RR,0.16; 95%CI, -0.67 to 0.98; p=0.71), ICU
Jember, Indonesia admission (RR,0.94; 95%CI, 0.78 to 1.13; p=0.50),
***
Department of General reoperation required (RR,0.78; 95%CI, 0.30 to 2.06;
Surgery, Soebandi General p=0.62), and 30-days mortality (RR,1.18; 95%CI, 0.76 to
Hospital, Faculty of 1.84; p=0.45). In contrast, even though the subgroup
Medicine Universitas analysis showed association that PHD longer in high
Jember, Indonesia FiO2 group for colorectal surgery (RR,0.80; 95%CI, 0.24

Correspondence: to 1.35; p=0.005), the high FiO2 significantly reduced
rifaldydana@gmail.com SSI and anastomotic leakage in abdominal surgery
(RR,0.78; 95%CI, 0.62 to 0.99; p=0.04 and RR,0.55;
95%CI, 0.36 to 0.85; p=0.008).
Conclusion: This meta-analysis provides evidence that
administration of 80% FiO2 even though association with
longer of PHD in colorectal surgery, it is associated with
a reduction in SSI and anastomotic leakage in patients
who underwent abdominal surgery. It contrasts for
sepsis, ICU admission, reoperation required, 30-day
mortality, SSI, and PHD in all-type surgery.
Keywords: adverse events; meta-analysis; oxygen;

surgery; surgical site infection.
Copyright @ 2023 Authors. This is an open access article distributed under the terms of the Creative Commons
Attribution- 4.0 International License (https://creativecommons.org/licenses/by/4.0/)
Medical Faculty of Universitas Sebelas Maret - PERDATIN Solo.

Rifaldy Nabiel Erisadana,Achmad Ilham Tohari,Yehuda Tri Nugroho Supranoto, Wiwien Sugih
Utami, Laksmi Indreswari
A Meta-Analysis of 80% Fraction of Inspired Oxygen on Surgical Site Infection in Patients Undergoing Surgery
INTRODUCTION myeloperoxidase into hypochlorous acid

Surgical site infections (SSI) are which has a bactericidal mechanism 5.
infection on incision site after surgery Recent meta-analysis showed that
that clinically important postoperative 80% fraction of inspiratory oxygen
adverse event because it leads to length clinically safe to reduce SSI in patients
of hospitalization, morbidty, mortality, undergoing surgery and no substantial of
and increases a considerable cost on safety concern against WHO
health care system1,2. A total of 135 recommendations6. However, further
from 4,893 (2.8%) abdominal surgeries studies were widely published still lead
developed SSI has been reported at Cipto to ongoing debate over the clinical use of
Mangunkusumo Hospital, Jakarta, high fraction of inspiratory oxygen. We
Indonesia, from January 2012 to conducted a review based on WHO
November 20173. Preventive strategies recommendations in terms of surgical
approach by surgical or anesthesia site infection as the primary outcome and
departments to overcome this condition adverse events such as sepsis,
were urgently needed in order to postoperative hospitalization days
enhanced satisfactory surgical care (PHD), anastomotic leakage, reoperation
system. World Health Organization required, and 30-days mortality as the
(WHO) have recommendation the use of secondary outcome in both patients with
80% Fraction of inspiratory oxygen or without endotracheal intubation.
(FiO2) as perioperative strategy to reduce METHODS
the risk or incidence of surgical site This systematic review and meta-
infection in adult patients with analysis was reported based on the
endotracheal tube intubation under Preferred Reporting Items for
general anesthesia4. High concentrations Systematic Reviews and Meta-analysis
of inspired oxygen might increase tissue (PRISMA) guideline 7.
oxygenation and thereby enhancing Database Searching and Study
oxidative killing by neutrophil as Selection
bactericidal host defence. This We performed database literature
mechanism is mediated when the searching in Pubmed, Google Scholar,
superoxide anion is converted to and ScienceDirect using the following
hydrogen peroxide and then catalyzed by
Solo Journal of Anesthesi, Pain and Critical Care | Vol 3 No 1 April 2023 34
34
Medical Faculty of Universitas Sebelas Maret - PERDATIN Solo
keywords: Oxygen, FiO2, (Surgical Site Data extraction

Infection OR SSI), and Surgery. All included studies underwent
We only included articles that data extraction by two independent
match our eligibility criteria: (1) reviewers (RNE and AIT). The main
Reported patients who underwent a outcome of this study is SSI. There were
major surgery aged 18 year or older; (2) many secondary outcomes such as the
The patients received an intervention incidence of sepsis, anastomotic leakage,
either high FiO2 (80%) or low FiO2 (30- PHD, ICU admission, reoperation, and
35%); (3) Reported at least one of the mortality. Several data were extracted
following outcomes: Surgical site from the studies including the author,
infection (SSI), sepsis, anastomotic year, sample size, age, type of surgery,
leakage, postoperative hospitalization duration of surgery, outcome, type of
days (PHD), ICU admission, reoperation, anesthesia, postoperative oxygenation,
and 30-days mortality; (4) The article used follow-up, and bacterial culture. Any
RCT study design; (5) Written in controversies between data extraction
English. The literature search was done were discussed with other authors.
in February 2022 without any year Risk of bias assessment
restriction. The risk of bias in each study was
All results from the databases assessed using Cochrane Risk of Bias 2
were inputted in Rayyan.ai, an artificial (ROB 2) tool9. The ROB 2 tool consists
intelligence online program that of five domains like selection bias,
integrated to expedite the initial performance bias, detection bias,
screening of abstracts and titles during attrition bias, and reporting bias. Each
studies selection process8. Two domain was graded as “low risk”, “some
independent reviewers (RNE and AIT) concern”, and “high risk” of bias.
selected the articles based on title and The risk of bias assessment was
abstracts. conducted by two authors (LI and YTS)
All articles that passed the title independently. Any difference in terms
and abstract selection were screened for of grading was discussed with other
the eligibility criteria. Any conflicts in authors. Publication bias was assessed
articles within the article selection were using a funnel plot if only there were 10
discussed with all authors. or more studies included in the analysis,
a symmetrical funnel plot is defined as abstract screening. After title and

low publication bias. abstract screening, 25 articles were
Data synthesis and analysis checked for eligibility by full-text
The data were analyzed both screening. Qualitative synthesis and
analyzed narratively and quantitatively quantitative analysis using meta-analysis
using meta-analysis. The meta-analysis were performed in 23 included articles.
was conducted using Review Manager Figure 1 shows the PRISMA flow chart.
(RevMan) 5.4 (Cochrane collaboration,
oxford, UK) with 95% confidence
interval (CI). Pooled risk ratio was used
to calculate the outcome of SSI, sepsis,
anastomotic leakage, ICU admission,
reoperation, and mortality.
In addition, pooled mean
difference (MD) was used to calculate
the outcome in PHD. Random Effects
Model (REM) and Fixed Effects Model
(FIM) were used based on the
heterogeneity (I2 > 50% determined as
high heterogeneity, I2<50% determined
as low heterogeneity) based on Cochrane
handbook of systematic reviews of
interventions10. A subgroup analysis was
Figure 1. PRISMA Flowchart
performed based on the type of surgery.
RESULTS
Study characteristics and Risk of Bias
Studies Selection
Table 1 and Table 2 summarize
Based on the database searching,
all the included RCT studies. The sample
we found a total of 1954 articles from
size varied between each study ranging
Pubmed, Google Scholar, and
from 38 to 2012 samples. The included
ScienceDirect. We conducted the
studies were conducted in several
duplicate screening automatically using
countries such as Austria1, USA6, Spain1,
Rayyan.ai and then underwent title and
Israel2, Denmark1, France1, Hong Kong1,
36
Italy3, India2, Iran1, China1, and The risk of bias varied from low risk –
multicenter countries3. high risk of bias. There are 7 studies
The risk of bias assessment was labeled as low risks of bias, 8 studies
conducted using Cochrane ROB 2 tool some concern/uncertain, and 8 studies
and presented in supplementary files. high risks of bias.
Table 1. Characteristic of included studies part 1
Study Sample Type of surgery Age Duration of surgery Intervention Patients outcomes
Size
High Low FiO2 High Low FiO2 High FiO2 Low FiO2
FiO2 FiO2
Greif et al, (2000) 500 Elective open 57±15 57±15 3.1±1.4 3.1±1.4 80% O2 with 30% O2 with SSI, PHD, ICU
Austria 11 colorectal (h) (h) 20% N2O 70% N2O admission
resection
Pryor et al, (2004) 160 Major 54±16 57±15 233±83 208±91 80% O2 35% O2 SSI, PHD, ICU
USA 12 abdominal (min) (min) admission
surgery
Belda et al, (2005) 291 Elective 64.2±11.8 62.3±12.5 161±62 159±61 80% O2 30% O2 SSI, PHD, ICU
Spain 13 colorectal (min) (min) admission
resection
Mayzler et al, 38 Elective 67±10 69±9 140±40 135±40 80% O2 with 30% O2 SSI, anastomotic
(2005) colorectal (min) (min) 20% N2O with 70% leakage
Israel 14 surgery N2O
Myles et al, 2012 Mixed surgeries 55.8±17 54.6±16 3.3±2.0 3.3±2.0 80% O2 with 30% O2 SSI, ICU admission,
(2007) (h) (h) 20% N2O with 70% 30-days mortality
Multicenter 15 N2O
Gardella et al, 143 Caesarean 31 (19– 28 (16– 48 (26– 52 (20– 80% O2 30% O2 SSI
(2008) section 46) 47) 87) (min) 141)
USA 16 (min)
Meyhoff et al, 1386 Acute or elective 64 64 128 (38– 132 (35– 80% O2 30% O2 SSI, ICU admission,
(2009) laparotomy (27–85) (34–84) 310) 295) anastomotic leakage,
Denmark 17 (min) (min) PHD, re 30-days
\ mortality
Colorectal
633 surgery NR NR NR NR 80% O2 30% O2 SSI
Bickel et al, 210 Open 28.5± 27.6±10.8 33.04±10. 32.75±10. 80% O2 with 30% O2 SSI, PHD
(2011) appendectomy 12.3 6 (min) 3 (min) 20% air with 70%
Israel 18 N2O
Scifres et al, 585 Caesarean 27.5±6.4 27.8±5.9 57.4±20.5 60.6±26.1 80% O2 25-35% O2 SSI
(2011) section (min) (min)
USA 19
Thibon et al, 434 Abdominal, 52.1±13.7 51.8±13.3 89±61 84±58 80% O2 30% O2 SSI
(2012) gynecologic, (min) (min)
France 20 breast (Mixed
surgeries)
Chen et al, (2013) 60 Open colorectal 62±12 60±15 A/199± A/184±85 80% O2 30% O2 SSI, PHD
Hong Kong 21 surgery 76 (min) (min)
Duggal et al, 831 Caesarean 29.2±5.6 29.5±5.8 NR NR 80% O2 30% O2 SSI and/or
(2013) section endometritis
USA 22
Schietroma et al, 171 gastrectomy and 68.4 (51– 67.8 (48– 175 180 80% O2 30% O2 SSI, anastomotic
(2013) subsequent 84) 82) (100–250) (118–270) leakage, reoperation
Italy 23 esophagojejunal (min) (min) required
anastomosis
Stall et al (2013) 235 Open reduction 42.3±12.1 42.5±12.2 233±88 228±88 80% O2 30% O2 SSI
USA 24 and internal (min) (min)
fixation
Williams et al, 160 Caesarean 24.6024 24.8961 51.2048 52.2467 80% O2 30% O2 SSI
USA 25
Kurz et al, (2015) 586 Colorectal 54±16 51±17 3.5±1.5 3.5±1.8 80% O2 30% O2 SSI, PHD, 30-days
Multicenter 26 resection (h) (h) mortality
Wasnik et al, 64 Open 27.15±10. 28.56±12. 61.87±10. 61.4±12.5 80% O2 30% O2 SSI, PHD
(2015) Appendectomy 46 22 6 (min) (min)
India 27
Fariba et al, 122 Caesarean 29.70±5.4 29.26±4.6 57.5±14.2 60±10.4 80% O2 30% O2 SSI
Iran 28
Schietroma et al, 239 Open perforated 58.3 (35– 57.8 (30– 63.2 (38– 58.7 (33– 80% O2 30% O2 SSI
(2016a) peptic ulcer 80) 82) 104) min 102) min
Italy 29 surgery
Schietroma et al, 85 Open colorectal 71.4 (55– 68.6 (49– 200 (95– 195 (100– 80% O2 30% O2 SSI, anastomotic
(2016b) resection 92) 86) 410) min 385) min leakage, reoperation
Italy 30 required
Mayank et al, 94 Elective 57.02±12. 53.36±14. 233.51±8 207.66±1 80% O2 with 33% O2 SSI, PHD,
(2019) colorectal 94 45 7.65 03.53(min 20% N2O with 66% anastomotic leakage
India 31 surgery (min) ) N2O
Ferrando et al, 740 Abdominal 64.2±12.8 63.9±13.9 214.2±93. 209.2±89. 80% O2 30% O2 SSI, PHD, 30-days
(2020) sutgery 3 (min) 7 (min) mortality
Multicenter 32
Xue-Fei Li et al, 251 Abdominal 54±14 53±13 190 (154– 200 (146– 80% O2 30% O2 SSI, sepsis, ICU
(2020) surgery 245) min 258) min admission
China 33
SSI= surgical site infection; PHD= postoperative hospitalization days; ICU= intensive care unit; min= minutes; h= hour
Table 2. Characteristic of included studies part 2

Study Type of SSI Type of Post-operative oxygenation Follow up Bacterial culture
Assesment anaesthesia for SSI
assesment
Greif et al (2000) ASEPSIS scores General 2 h by NRBM 15 days Escherichia coli

Austria 11 Enterococcus
Pseudomonas aeruginosa
Staphylococcus aureus
S. epidermidis
Enterobacter
Pryor et al, (2004) NR General 2 h by CN for low group and NRBM 14 days Escherichia coli
USA 12 for high group Bacteroides fragilis
Enterococcus faecalis
Coagulase-negative
staphylococcus
No species identified
Belda et al, (2005) ASEPSIS scores General 6 h by NRBM 14 days NR

Spain 13 and CDC criteria
Mayzler et al, (2005) NR General 2 h by face mask 30 days NR
Israel 14
Myles et al, (2007) NR General NR 30 days NR
Multicenter 15
Gardella et al, (2008) NR Regional 2 h by NRBM 14 days Group B streptococcus
USA 16
Meyhoff et al, (2009) ASEPSIS scores General 2 h by NRBM 14 days NR
Denmark 17 and CDC criteria
Bickel et al, (2011) ASEPSIS scores General 2 h by CN for low group and NRBM 14 days NR
Israel 18 for high group
Scifres et al, (2011) NR Regional 2 h by CN for low group and NRBM 28 days Group B streptococcus
USA 19 for high group
Thibon et al, (2012) CDC criteria General NR 30 days Staphylococcus aureus
France 20 coagulasenegative
staphylococcal species
Pseudomonas aeruginosa
Gram-negative bacteria
Chen et al, (2013) ASEPSIS scores General 24 h by facemask 30 days NR
Hong Kong 21 and CDC criteria
Duggal et al, (2013) NR Regional 1 h by facemask 14 days NR
USA 22
Schietroma et al, (2013) NR General 6 h by facemask with reservoir NR NR
Italy 23
Stall et al, (2013) ASEPSIS scores General 2 h by CN for low group and NRBM 12 weeks NR
USA 24 and CDC criteria for high group
Williams et al, (2013) CDC criteria Regional 2 h by aerosol mask 6 weeks NR
USA 25
Kurz et al, (2015) CDC criteria General 1 h by NRBM 30 days NR
Multicenter 26
Wasnik et al, (2015) ASPESIS scores NR 2h 10 days NR
India 27
Fariba et al, (2016) ASEPSIS scores Regional 6 h by normal mask for low group 14 days NR
Iran 28 and venturi mask for high group
Schietroma et al, (2016a) ASEPSIS scores General 6 h by NRBM with a reservoir 14 days NR
Ital 29 and CDC criteria
Schietroma et al, (2016b) NNIS, SENIC General 6 h by NRBM 14 days NR
Italy 30 scales, and
ASEPSIS scores
Mayank et al, (2019) ASEPSIS score General 6 h by standard venturi mask for low 2 days NR
India 31 and CDC criteria group and NRBM venturi face mask
for high group
Ferrando et al, (2020) CDC criteria General and 3 h by venturi mask for low group 30 days NR
Multicenter 32 Regional and NRBM with a reservoir for high
group
Xue-Fei Li et al, (2020) CDC criteria General NR 7 days NR
China 33
NR= Not Reported; h= hour; CN= canule nasal; NRBM= non rebreathable mask
Outcomes: Surgical site Infection Overall, high FiO2 was not associated
23 studies reported on surgical with an reducing risk of SSI in all-type
site infection incidences with 656/4672 surgery (pooled RR 0.85; 95% CI 0.72 –
events in the low FiO2 and 558/4671 1.01; p=0.07). There was considerable
events in the high FiO2 (Figure 2). heterogeneity in the analysis (I2=52%).
38
Accordance results also showed by significant in terms to reducing the

subgroup analysis revealed that high incidence of anastomotic leakage for
FiO2 statistically no significant to abdominal surgery (pooled RR 0.55;
reduced SSI for colorectal surgery 95% CI 0.36 – 0.85; p=0.008).
(pooled RR 0.84; 95% CI 0.64 – 1.10; Low heterogeneity was observed
p=0.20), open appendectomy (pooled in the analysis (I2=0%).
RR 0.41; 95% CI 0.16 – 1.03; p=0.06), Four studies conducted for
and caesarean section (pooled RR 1.20; colorectal surgery as subgroup analysis
95% CI 0.91 – 1.58; p=0.21). showed statistically significant
In contrast, high FiO2 association between high FiO2 and
significantly reduced SSI in patients who anastomotic leakage (pooled RR 0.61;
underwent abdominal surgery (pooled 95% CI 0.37 – 1.00; p=0.05).
RR 0.78; 95% CI 0.62 – 0.99; p=0.04) Heterogeneity between studies was low
with high heterogeneity between studies (I2=0%).
(I2=61%). Outcomes: Postoperative
Outcomes: Sepsis hospitalization days
Two studies reported on sepsis Eight studies reported on
with 16/826 events in low FiO2 and postoperative hospitalization days
23/811 events in high FiO2. (PHD) available only for abdominal
This results showed the trend of surgery. The result showed not
sepsis higher in high FiO2 group but the significantly differing between the
pooled estimates did not demonstrate groups (pooled MD 0.16; 95% CI -0.67
statistically significant (pooled RR 1.47; – 0.98; p=0.71). Heterogeneity between
95% CI 0.78 – 2.76; p=0.23). There was studies was high (I2=0.74).
mild heterogeneity (I2=0%). Subgroup analysis was
Outcomes: Anastomotic leakage conducted in terms for open
Anastomotic leakage only appendectomy showed no significantly
available for abdominal surgery and differing (pooled MD -1.25; 95% CI -
conducted by six trials with 51/466 3.23 – 0.74; p=0.22) with high
events in low FiO2 and 28/464 in high heterogeneity (I2=80%). However,
FiO2 (Figure 3). The pooled estimates instead reducing the PHD for colorectal
showed that high FiO2 statistically surgery as subgroup analysis, high FiO2
showed statistically significant increase – 1.35; p=0.005). A low heterogeneity

of PHD (pooled MD 0.80; 95% CI 0.24 was observed (I2 = 0%).
Surgical site infection
Figure 2. Forest Plot for Incidence of SSI between High FiO2 Group and Low FiO2 Group
40
a) Sepsis
b) Anastomotic leakage
c) Postoperative hospitalization days
Figure 3. Forest Plot for Incidence of Sepsis, Anastomotic leakage, and Postoperative
hospitalization days between High FiO2 Group and Low FiO2 Group
d) ICU Admission
e) Reoperation required
f) 30-days mortality
Figure 4. Forest Plot for ICU Admission, Reoperation Required, and 30-days mortality between
High FiO2 Group and Low FiO2 Group
Outcomes: ICU admission FiO2 group and 194/2286 in high FiO2

Six studies reported on ICU group. There was statistically no
admission with 210/2314 patients in low significant in terms of ICU admission for
42
all-type surgery between the groups – 1.84; p=0.45). A low heterogeneity

(pooled RR 0.94; 95% CI 0.78 – 1.13; was observed (I2=43).
p=0.50) with low heterogenity was DISCUSSION
observed (I2=1%). The subgroup A meta analysis of 23 RCTs
analysis was conducted for abdominal involving 9,343 patients was conducted
surgery and colorectal surgery also in both patients with or without
showed statistically no significant endotracheal intubation in order to
difference (pooled RR 1.04; 95% CI 0.76 developing the WHO guideline. This
– 1.43; p=0.80) and (pooled RR 0.52; study showed no evidence for a benefit
95% CI 0.24 – 1.16; p=0.11) with low of the use high FiO2 (80%) compared
heterogeneity was observed (I2=7%) and low FiO2 (30-35%) to prevent or
(I2=0%). reducing the risk of SSI in all-type
Outcomes: Reoperation required surgery although the incidence of SSI
Four studies reported on was higher in low FiO2 group. In
reoperation required, where of 117/909 contrast, previous meta-analysis similar
events observed in the low FiO2 group with WHO guideline revealed that high
and 112/893 events in the high FiO2 FiO2 reducing the SSI risk in surgical
group. There was no significant patients under general anaesthesia with
difference in the reoperation required endotracheal intubation4,34. Although
between the groups (pooled RR 0.78; there are six additional studies where of
95% CI 0.30 – 2.06; p=0.62). High three studies are the most recent 31-33 and
heterogeneity was observed in the three other are studies that have done of
analysis (I2=54%). investigation enhanced that incidence of
Outcomes: 30-days mortality SSI still higher in low FiO2 group, there
Four studies reported on 30-days are six studies showed contradictory
mortality with 35/2341 events in the low incidence with relatively greatest RR
FiO2 group and 41/2329 events in the than in other seventeen studies
12,16,19,21,26,31
high FiO2 group. 30-days mortality was . Subgroup analysis in terms
observed higher in High FiO2 group, but of colorectal surgery also showed no
there was no statistically significant evidence benefit of the use high FiO2
different (pooled RR 1.18; 95% CI 0.76 compared low FiO2, this results similar
with previous meta analysis even though
these previous study was conducted not The incidence of ICU admission
only for RCTs35. Caesarean section and and reoperation required was higher in
appendectomy that performed by a lack low FiO2 group but did not statistically
of included studies demonstrate that high significant. The beneficially evidence of
FiO2 no evidence for benefit to prevent high FiO2 for secondary outcomes was
SSI. However, modification of subgroup observed only for anastomotic leakage in
analysis performed for all-type terms of both abdominal surgery and
abdominal surgery suggest that high colorectal surgery. This results contrasts
FiO2 beneficially to prevent or reducing with previous meta-analysis where of the
the risk of SSI. included studies conducted by multiple
Instead reducing the study design35. The beneficially of high
postoperative adverse events, this meta FiO2 for anastomotic leakage may
analysis showed that the trend of sepsis related with increases of tissue perfusion
and 30-days mortality was higher in high in order to maintained mechanical
FiO2 group even though the results no stability of anastomosis37.
statistically significant. PHD only Our meta-analysis was carry out
showed statistically significant in by the most up to date search of the
subgroup analysis in term for colorectal literature and clinically-important
surgery revealed that the use of high outcomes. However, this study has some
FiO2 increases duration of PHD. limitations. First, the subgroup analysis
Previous meta-analysis showed no performed by type of surgery instead of
definite signal of harm with 80% FiO2 in patient who undergo endotracheal
surgical patients undergoing general intubation or not. However, there are no
anaesthesia because of there is lack of previous meta analysis that performed by
safety-related included studies that type of surgery especially to investigated
suggest to discourage this perioperative the use of high FiO2 to reducing or
treatment 6. Supplementation of high and prevent incidence of SSI. Second, the
low FiO2 did not differentially of the time of literature search not limited to the
mortality, pneumonia, respiratory last 5 years, this condition was
failure, and length of hospital stay, but performed following WHO guideline
high FiO2 associated with a significantly which is the WHO latest guideline
higher incidence of atelectasis 6,36. conducted by meta-analysis studies that
44
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Vol 3 No 1 April 2023 E-ISSN : 2797-0035

Solo Journal of Anesthesi, Pain and Critical Care P- ISSN : 2776-1770

Keywords: adverse events; meta-analysis; oxygen;

Medical Faculty of Universitas Sebelas Maret - PERDATIN Solo.

INTRODUCTION myeloperoxidase into hypochlorous acid

keywords: Oxygen, FiO2, (Surgical Site Data extraction

a symmetrical funnel plot is defined as abstract screening. After title and

Table 2. Characteristic of included studies part 2

Greif et al (2000) ASEPSIS scores General 2 h by NRBM 15 days Escherichia coli

Belda et al, (2005) ASEPSIS scores General 6 h by NRBM 14 days NR

Accordance results also showed by significant in terms to reducing the

showed statistically significant increase – 1.35; p=0.005). A low heterogeneity

Surgical site infection

c) Postoperative hospitalization days

Outcomes: ICU admission FiO2 group and 194/2286 in high FiO2

all-type surgery between the groups – 1.84; p=0.45). A low heterogeneity

included studies above 5 years of REFERENCES

In conclusion, based on the ML, Lalisang TJM. Surgical site

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oxygen for the prevention of trial. Obstetrics and Gynecology.

26. Kurz A, Fleischmann E, Sessler Site Infection after Surgery for

open-lung ventilatory strategy: a Infection in Colorectal Surgery: A

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