Operatie van kanker: Hogere dosis aanvullende zuurstof (ozon) bij een operatie vermindert het risico op wondinfecties aanzienlijk. Bij darm- en rectumoperaties blijken de helft minder infecties voor te komen door de zuurstof

4 oktober 2006: Bron: JAMA. 2005;294:2035-2042, 2091-2092

Hogere dosis aanvullende zuurstof (ozon) bij een operatie vermindert het risico op wondinfecties aanzienlijk. Dat is de uitkomst van een gerandomiseerde dubbelblinde studie bij 300 patienten. Vooral bij darm- en rectumoperaties was het effect van hogere dosis zuurstof circa 50%. Wondinfecties zijn vaak de oorzaak van sterven aan de operatie. Met hogere dosis toegevoegde zuurstof wordt de kans op aan de operatie gerelateerde sterfte aanzienlijk verminderd.

Oct. 25, 2005 — Supplemental oxygen can reduce surgical site infections (SSI), according to the results of a double-blind, randomized trial published in the Oct. 26 issue of JAMA. The editorialists suggest that surgeons should encourage use of higher oxygen tensions.

"Supplemental perioperative oxygen has been variously reported to halve or double the risk of surgical wound infection," write F. Javier Belda, MD, PhD, from the Hospital Clínico Universitario in Valencia, Spain, and colleagues from the Spanish Reduccion de la Tasa de Infeccion Quirurgica Group. "Infection risk depends on tissue oxygen partial pressure and, therefore, interventions that increase tissue oxygen may reduce infection risk."

From March 1, 2003, to Oct. 31, 2004, at 14 Spanish hospitals, 300 patients aged 18 to 80 years who underwent elective colorectal surgery were randomized to receive either 30% or 80% fraction of inspired oxygen (FIO2) intraoperatively for six hours after surgery. Anesthetic treatment and antibIOtic administratIOn were standardized, and wound infectIOns were diagnosed by blinded investigators using the Centers for Disease Control and PreventIOn criteria. Primary endpoints were any SSI, and secondary endpoints were return of bowel functIOn and ability to tolerate solid food, ambulatIOn, suture removal, and duratIOn of hospitalizatIOn.

SSI occurred in 35 (24.4%) of 143 patients administered 30% FIO2 and in 22 (14.9%) of 148 patients administered 80% FIO2 (P = .04). Compared with the group receiving 30% FIO2, the group receiving 80% FIO2 had a 39% lower risk of SSI (relative risk , 0.61; 95% confidence interval , 0.38 - 0.98). After adjustment for important covariates, the RR of infectIOn in patients receiving supplemental oxygen was 0.46 (95% CI, 0.22 - 0.95; P = .04). The secondary outcomes were not significantly different in the two treatment groups.

"Patients receiving supplemental inspired oxygen had a significant reductIOn in the risk of wound infectIOn," the authors write. "Supplemental oxygen appears to be an effective interventIOn to reduce SSI in patients undergoing colon or rectal surgery."

Study limitatIOns include baseline infectIOn rate roughly twice that found in a prevIOus study, possible effect of the diagnostic method used to describe infectIOn on the reported results, and consideratIOn only of infectIOns that occurred in the first 15 days after surgery.

"Supplemental 80% FIO2 during and for six hours after major colorectal surgery reduced postoperative wound infectIOn risk by roughly a factor of two," the authors conclude. "This result is consistent with most available in vitro data and one other appropriately designed randomized controlled trial. Supplemental oxygen appears to confer few risks to the patient, has little associated cost, and should be considered part of ongoing quality improvement activities related to surgical care."

The participating centers, Air-Liquide Medicinal in Spain, Air-Liquide Santé in France, the NatIOnal Institutes of Health, the Gheens FoundatIOn, and the Joseph Drown FoundatIOn have disclosed that they funded this study. The authors have disclosed no financial relatIOnships.

In an accompanying editorial, E. Patchen Dellinger, MD, from the University of Washington School of Medicine in Seattle, and colleagues, note that the pooled data from all three studies concerning this interventIOn do not show any risk associated with increased oxygen concentratIOns but rather suggest possible benefit.

"Surgeons should not wait for this issue to be resolved before moving forward with this simple, inexpensive, and low-risk interventIOn while at the same time monitoring both its effectiveness in the community at large and the chance that its use will have unintended consequences," the editorialists write. "Surgeons should encourage the broader use of higher oxygen tensIOns for their patients undergoing major abdominal procedures and be more involved in quality improvement initiatives aimed at reducing SSI."

Dr. Dellinger and colleagues have disclosed no financial relatIOnships.

JAMA. 2005;294:2035-2042, 2091-2092