Anaesthetist Receives $1.4m Grant To Improve Surgery Outcomes

A New Zealand anaesthetist has been awarded $1.4 million for a study into optimising oxygen administration during surgery to reduce wound infection and other post-surgical complications.

Dr Daniel Frei, a cardiothoracic anaesthetist at Wellington Regional Hospital, secured the funding from the Health Research Council of New Zealand for the Hospital Operating Theatre Randomised Oxygen clinical trial, or HOT-ROX.

More than 300,000 New Zealanders receive oxygen during and after surgery each year, but the optimal level of oxygen to administer is unknown.

Dr Frei says as well as examining how to reduce wound infection and other complications, HOT-ROX will explore the effect of different oxygen levels on overall recovery, quality of life, and mortality.

“We’ll be comparing three different levels of oxygen exposure and primarily looking at surgical site infection rates after surgery.

“One of the reasons we’re looking at this is because there’s currently insufficient evidence to support administering oxygen liberally during surgery, but also because there are very few studies that have examined the safety of this approach.

“Although the World Health Organization made a recommendation stating that patients undergoing surgery with tracheal intubation should be given 80 per cent or more oxygen under anaesthesia, we know that this is not what most clinicians currently do, and it has created some controversy.”

The study will be carried out jointly in New Zealand and Australia, where it will be the first trial of its kind as part of a new clinical trials platform at Melbourne’s Monash University, known as the PROMPT (Perioperative Medicine Platform Trials) platform.

The trial will be part of ANZCA’s Clinical Trials Network. ANZCA clinical trials are facilitated at more than 130 sites across New Zealand and Australia, bringing together world leaders in anaesthesia research.

It is expected about 1000 patients will be involved in the trial in New Zealand, with a larger cohort in Australia.

A sub-study during HOT-ROX will investigate the accuracy of pulse oximeters, used to continuously measure the oxygen level in the bloodstream during surgery and in illnesses where oxygen therapy may be needed.

Overseas studies suggest pulse oximeters may be unreliable in people with very dark skin, and this study will gauge whether they are reliable in the range of skin tones found in New Zealand.

“Particularly in African American populations there’s evidence that pulse oximeters overestimate the true blood oxygen levels, so a pulse oximeter reading might say the blood oxygen saturation is at 90 per cent but if you do a blood sample it’s 89 per cent.

“It matters because obviously hypoxemia is potentially dangerous, but also because if your saturations reach a certain threshold, that could trigger a treatment pathway where you might be admitted to hospital or the intensive care, so if that’s not detected it may result in inferior care.

“The question we’re asking is whether pulse oximetry inaccuracy is occurring with the range of skin tones we see in New Zealand, and particularly among Māori, and Pacific peoples,” Dr Frei says.

The trial is expected to begin in the second half of 2025.

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