To the Editor: Dr Pryor and colleagues1 reported that patients who received 80% inspired oxygen during and 2 hours after abdominal surgery had a significantly higher rate of surgical site infections (SSIs) than did those who received 35% oxygen. Although the authors controlled the concentration of inspired oxygen, they apparently did not consider other crucial factors such as fluid management, temperature, anesthetic management, and pain control. Tissue perfusion, and thus oxygenation, is often inadequate when these variables are not closely monitored and controlled.2
By contrast, Greif et al3 reported that 80% inspired oxygen decreased SSIs by 50%, after controlling for these other factors. Pryor et al did not report whether they attempted to optimize tissue perfusion, a factor recognized as critical by the US Centers for Disease Control and Prevention.4
There are a number of other problems with the study. For example, the sample is smaller and more heterogeneous than that in the study by Greif et al. Furthermore, the 2 groups appear to have differed in their baseline comorbid conditions. Patients receiving 80% oxygen were more likely to be obese, had longer operations, and lost more blood. All these factors may be associated with increased risk of SSI. Five patients in the group receiving 80% oxygen remained intubated in the postanesthesia care unit vs only 1 in the group receiving 35% oxygen, a factor that was significantly associated with SSI using multivariate analysis. The high infection rate (25%) in the group receiving 80% oxygen further suggests failure of randomization and/or inadequate sample size. Finally, wound infections were identified by retrospective chart review, a notoriously inaccurate approach.5
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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