Associations between the intraoperative fraction of inspired intraoperative oxygen administration and days alive and out of hospital after surgery
Daniel R. Frei,
Matthew R. Moore,
Michael Bailey,
Richard Beasley,
Douglas Campbell,
Kate Leslie,
Paul S. Myles,
Timothy G. Short,
Paul J. Young
Affiliations
Daniel R. Frei
Department of Anaesthesia and Pain Management, Wellington Hospital, Wellington, New Zealand; Medical Research Institute of New Zealand, Wellington, New Zealand; Corresponding author. Department of Anaesthesia and Pain Management, Wellington Hospital, 49 Riddiford Street, Newtown, Wellington 6021, New Zealand.
Matthew R. Moore
Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
Michael Bailey
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Richard Beasley
Medical Research Institute of New Zealand, Wellington, New Zealand; Victoria University of Wellington, Wellington, New Zealand
Douglas Campbell
Department of Anaesthesiology, University of Auckland, Auckland, New Zealand; Department of Anaesthesia and Peri-operative Medicine, Auckland City Hospital, Auckland, New Zealand
Kate Leslie
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
Paul S. Myles
Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital Melbourne, Victoria, Australia
Timothy G. Short
Medical Research Institute of New Zealand, Wellington, New Zealand; Department of Anaesthesia and Peri-operative Medicine, Auckland City Hospital, Auckland, New Zealand
Paul J. Young
Medical Research Institute of New Zealand, Wellington, New Zealand; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; Department of Intensive Care, Wellington Regional Hospital, Wellington, New Zealand
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 (FiO2), 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 (FiO2 ≤ 0.4, 0.41–0.59, ≥0.6). The primary outcome was days alive and out of hospital at 90 days (DAOH90). 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 FiO2 and DAOH90 when high FiO2 was analysed according to three groups. Using high FiO2 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 FiO2 was associated with increased surgical site infection: the adjusted odds ratio (OR) for low compared with high FiO2 was 1.53 (95% CI 1.12–2.10). Increasing FiO2 was associated with respiratory complications: the adjusted OR associated with each 10% point increase in FiO2 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.
