Real-world evidence of hyperbaric oxygen therapy on cardiovascular outcomes in patients with chronic osteomyelitis

Chi-Jung Tai; Chun-Kuan Lu; Chun-Ying Lee; Su-Shin Lee; Yi-Hsin Yang

doi:10.1016/j.jiph.2023.03.006

Real-world evidence of hyperbaric oxygen therapy on cardiovascular outcomes in patients with chronic osteomyelitis

J Infect Public Health. 2023 May;16(5):705-712. doi: 10.1016/j.jiph.2023.03.006. Epub 2023 Mar 7.

Authors

Chi-Jung Tai¹, Chun-Kuan Lu², Chun-Ying Lee³, Su-Shin Lee⁴, Yi-Hsin Yang⁵

Affiliations

¹ Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Family Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan; Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Department of Orthopedic Surgery, Park One International Hospital, Kaohsiung, Taiwan.
³ Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Plastic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan; School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: yhyang@nhri.edu.tw.

PMID: 36940497
DOI: 10.1016/j.jiph.2023.03.006

Abstract

Background: The effectiveness of hyperbaric oxygen (HBO) therapy for chronic osteomyelitis remains inconclusive. In particular, recent studies have shown that chronic osteomyelitis is a crucial risk factor for cardiovascular diseases. However, the preventive effect of HBO on cardiovascular events has not been reported in patients with chronic osteomyelitis.

Methods: We conducted a population-based cohort study to evaluate the impact of HBO on patients with chronic osteomyelitis. Overall, 5312 patients with chronic osteomyelitis were selected from the Taiwan National Health Insurance Database to evaluate the impact of HBO in patients with chronic osteomyelitis. Propensity-score (PS) matching and inverse probability weighting (IPTW) were employed to balance covariates between the HBO and non-HBO groups. The primary outcome was all-cause mortality. The secondary outcomes were myocardial infarction (MI) and stroke hospitalisation. Furthermore, we evaluated the appropriate timing for HBO intervention by the restricted cubic spline (RCS) functions.

Results: After 1:4 PS-matching, the HBO group (n = 265) was associated with lower 1-year mortality (hazard ratio [HR], 0.49; 95 % confidence interval [CI], 0.25-0.95) than the non-HBO group (n = 994); this was consistent with the IPTW weighting results (HR, 0.25; 95 % CI, 0.20-0.33). The risk of stroke was lower in the HBO group (HR, 0.46; 95 % CI, 0.34-0.63) than that in the non-HBO group. However, HBO therapy failed to reduce the risk of MI. Using the RCS model, patients with intervals within 90 days (HR, 1.38; 95 % CI, 1.04-1.84) presented a significant risk of 1-year mortality. After 90 days, as the length of interval increased, the risk gradually decreased and became insignificant.

Conclusion: The present study revealed that adjunctive HBO could benefit the 1-year mortality and stroke hospitalisation in patients with chronic osteomyelitis. HBO was recommended to be initiated within 90 days of chronic osteomyelitis hospitalisation.

Keywords: Cardiovascular risk; Hyperbaric oxygen therapy; Inverse probability weighting; Osteomyelitis; Propensity-score matching.

MeSH terms

Cohort Studies
Humans
Hyperbaric Oxygenation* / adverse effects
Myocardial Infarction*
Osteomyelitis* / therapy
Stroke* / epidemiology
Stroke* / therapy