Comparison of the efficacy of hyperbaric oxygen therapy in patients with postoperative spinal and extremity wound lnfections

Abstract

Background: Hyperbaric oxygen (HBO) has been shown to promote the healing of ischemic and infected tissue; therefore, it may be useful for treating non-healing postoperative wound infection. The purpose of this study was to compare the efficacy of HBO therapy in the treatment of postoperative spinal and extremity wound infections. Methods: From 1995 to 2011, 284 patients with postoperative wound infection were enrolled in this study and divided into 2 groups: groups I, 26 patients (spinal wound infection) and group II, 235 patients (upper and lower extremities wound infection). HBO therapy was indicated when infection showed no improvement of clinical symptoms/signs and laboratory testing following appropriate antibiotic therapy for at least 2 weeks. All patients received HBO therapy one cycle (20 times) as an adjunctive treatment, and the following data were collected retrospectively: age, sex, comorbidity (diabetes mellitus, liver cirrhosis, and end-stage renal disease), and type of bacteria (gram-positive, gram-negative, and anaerobic). These clinical results and outcomes after HBO therapy were analyzed Results: Sex and diabetes mellitus incidence were significantly different between the 2 groups; the extremities infection group had more male and fewer diabetic patients. No significant difference between the groups was found in terms of other factors, comorbidity, or type of bacteria. Although the overall clinical outcome after HBO treatment was not significantly different between the groups, the spinal group showed a higher percentage of excellent results after infection with a gram-positive pathogen. Conclusion: Patients with post-operative spinal wound infection under HBO therapy have similar treatment responses to patients with the extremities wound infection. Clinical outcomes are not affected by comorbidities such as diabetes mellitus, liver cirrhosis, or end-stage renal disease. Therefore, HBO therapy is recommended as an adjunctive treatment for postoperative spinal wound infection.