Peri-Surgical HBOT: Enhancing Outcomes through Pre- and Post-Op Oxygenation
Peri-Surgical HBOT: Enhancing Outcomes through Pre- and Post-Op Oxygenation
1. Rationale
Surgery provokes a systemic stress response—hypoxia in marginal tissues, inflammation, and risk of infection—that underlies up to 50 % of postoperative complications (e.g., surgical-site infections, anastomotic leaks). Adjunctive HBOT before and after surgery (“preconditioning” and “postconditioning”) can counter these processes by super-saturating plasma with O₂, modulating immune function, and accelerating repair.
2. Core Mechanisms of Benefit
- Enhanced tissue oxygenation • 2.0–2.5 ATA HBOT raises dissolved O₂ in plasma ~10-fold versus room air, ensuring adequate delivery to poorly perfused zones.
- Anti-inflammatory and anti-edema effects • Hyperoxia induces vasoconstriction in healthy tissues—reducing edema—while maintaining perfusion in injured areas and downregulating pro-inflammatory cytokines.
- Angiogenesis & collagen synthesis • By upregulating VEGF and fibroblast activity, HBOT fosters neovascularization, critical for wound healing and anastomotic integrity.
- Enhanced leukocyte killing & infection control • HBOT amplifies neutrophil oxidative burst and inhibits anaerobic bacteria, cutting surgical-site infection rates.
3. Clinical Evidence
A 2020 systematic review of 13 RCTs (627 patients) found that peri-operative HBOT improved ≥1 key outcome (wound healing, infection rates, graft viability) in 10 trials versus standard care or sham, with only one study showing no benefit and one negative trial. Notably:
- Abdominoplasty: pre-op HBOT reduced seroma formation and accelerated incisional healing versus controls.
4. Example Peri-Surgical HBOT Protocol
| Phase | Timing | Pressure | Duration | Sessions |
|---|---|---|---|---|
| Preconditioning | 5 days before surgery | 2.0 ATA | 60–90 min | Daily |
| Postconditioning | Start 24 h post-op | 2.0 ATA | 60–90 min | Daily × 5–7 |
- Chamber: monoplace or multiplace, 100 % O₂
- Air breaks: 5 min every 20 min to reduce CNS O₂ toxicity
- Adjuncts: optimize hemoglobin, control glucose, maintain normothermia
5. Safety & Monitoring
- Risks: ear/sinus barotrauma, oxygen toxicity (monitor for seizures, chest tightness)
- Monitoring: pre- and post-HBOT ENT exam, pulmonary function, and neurologic checks
6. Future Directions
- Imaging-guided HBOT “dose painting” via real-time tissue pO₂ sensors
- Combining HBOT with peri-op immunonutrition (e.g., arginine, omega-3) for additive anti-inflammatory effects
- Personalized regimens based on surgical risk calculators and genetic markers of wound healing
— By integrating a short course of HBOT around the surgical window, clinicians can significantly lower postoperative complications, speed tissue repair, and shorten hospital stays—transforming HBOT from a niche rescue therapy into a preventive peri-operative tool.