A meta-analysis of the effect of inspired oxygen concentration on the incidence of surgical site infection following cesarean section

Background: There has been interest in using high inspired oxygen concentrations to reduce surgical site infections in the obstetric population. Previous meta-analyses looking at the effect of high-concentration oxygen in other surgical populations have reported conflicting results. However, no meta-analysis has been performed on women undergoing cesarean section, who are generally a healthier population and thus may have different outcomes. The aim of this study was to complete a meta-analysis comparing high (>60%) and low (<40%) inspired concentrations of oxygen and determine the risk of surgical site infections in patients undergoing cesarean section. Methods: A full systematic review and meta-analysis were completed. Two independent literature searches were conducted using electronic databases, bibliographies and sources of gray literature to identify appropriate randomized controlled studies. These studies were assessed for quality and the results were pooled. Results: Five studies, with a total of 1966 patients, were included in the review. There was no evidence that the perioperative use of high concentrations of oxygen reduced surgical site infections in this group (risk ratio 1.12, 95% confidence interval 0.86-1.46, P = 0.40). The meta-analysis has an overall moderate GRADE. Conclusions: There is no evidence to suggest a difference in risk of surgical site infection by administration of high inspired oxygen concentrations among women undergoing cesarean section. Future studies with better adherence to the intervention may affect the results of this analysis. (C) 2013 Elsevier Ltd. All rights reserved.