Perioperative Supplemental Oxygen for the Prevention of Surgical Site Infection After Cesarean Section: A Systematic Review of Existing Literature.

Initial systematic reviews demonstrated the reduction of surgical site infection (SSI) following perioperative oxygen supplementation. SSI among colorectal surgeries was reduced by more than 50% with high-flow oxygen. However, recent randomized trials are coming up with conflicting results. The objective of this review was to comprehend whether the application of perioperative supplemental oxygen decreased the hazard of SSI following cesarean delivery. The initial search identified 95 studies. After screening title and abstracts 59 studies were included, and 33 studies were found to be relevant after checking eligibility. After a careful analysis, five articles were found fit for this systematic review. Extracted information included study design and methodology, the cumulative incidence of post-cesarean SSI following supplemental oxygen, the odds ratio, and associated variability for all factors considered in univariate and/or multivariate analysis. The cumulative incidence of the standard care group and supplemental oxygen group were comparable in all five studies with statistically significant differences. The secondary outcomes such as hospital readmission, wound separation, and intravenous antibiotics were similar in both groups as stated in the two studies. The rate of SSI in diabetics was 6.9% and 14.4% in the standard care group and supplemental oxygen group, respectively, as analyzed in a study. An increase in intra-operative blood loss was found to be the major risk factor leading to SSI. In one of the studies, Caucasian race, increased basal metabolic index, and prolonged surgery were associated with increased risk of SSI. There was no difference in neonatal umbilical artery pH resulting from supplemental oxygen during cesarean. The available literature is quite sufficient to prove that supplemental oxygen offers no added benefit in reducing post-cesarean SSI. Hence, we do not recommend its use for this purpose.