Disclosures: O’Toole reports being a paid consultant for Imagen and Stryker; being a paid presenter or speaker for Zimmer; receiving IP royalties from Lincotek; and having stock or stock options in Imagen. Please see the study for all other authors’ relevant financial disclosures.
May 13, 2022
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Supplemental oxygen reduced surgical site infection rate for lower extremity fractures

Disclosures: O’Toole reports being a paid consultant for Imagen and Stryker; being a paid presenter or speaker for Zimmer; receiving IP royalties from Lincotek; and having stock or stock options in Imagen. Please see the study for all other authors’ relevant financial disclosures.
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According to published results, supplemental perioperative oxygen reduced the risk of surgical site infection among adults who underwent surgery for tibial plateau, tibial pilon or calcaneal fractures.

In a randomized controlled trial, Robert V. O’Toole, MD, and colleagues from the Major Extremity Trauma Research Consortium analyzed 1,231 patients with tibial plateau, tibial pilon or calcaneal fractures who underwent fixation surgery. Researchers randomized a treatment group of 616 patients to receive a high fraction of inspired oxygen (80% FiO2) and a control group of 615 patients to receive a low fraction of inspired oxygen (30% FiO2). Both groups received supplemental oxygen treatment in the OR and for up to 2 hours in the recovery room, according to the study.

OT0522O'Toole_Graphic_01
Researchers determined this effect was driven by a reduction in superficial SSI. Data were derived from O’Toole RV, et al. J Bone Joint Surg. 2022;doi:10.2106/JBJS.21.01317.

Outcome measures, which were analyzed at 90 days, 182 days and 365 days, included deep surgical site infection (SSI) requiring surgery and superficial SSI treated with antibiotics.

Overall, SSI occurred in 7% of patients (n = 40) in the treatment group and in 10.7% of patients (n = 60) in the control group. Researchers noted a similar effect at 90 days and 365 days. According to the study, they determined the effect was driven by a reduction in superficial SSI.

“This large, blinded, randomized controlled trial provides evidence that high perioperative FiO2 reduces the overall risk of SSI in patients with a fracture of the tibial plateau, pilon or calcaneus at increased risk for infection,” the researchers wrote in the study. “This intervention appears to provide some clinical benefit of at least reducing superficial infections, is low-cost, and likely has few risks in this patient population,” they added.