Perioperative oxygen is routinely used, but evidence of its clinical impact remains inconsistent, leading to variable practice. The aim of this work was to provide a comprehensive overview of the effectiveness of perioperative oxygen therapy strategies. We searched multiple databases for systematic reviews comparing perioperative oxygen strategies. Two reviewers independently extracted data. The co-primary outcomes were surgical site infection (SSI) and mortality. We classified systematic reviews with the largest number of trials as anchoring reviews. We updated anchoring reviews with data from more recent RCTs. We assessed the risk of bias of the anchoring reviews using the ROBIS tool, updated meta-analyses and subgroup analyses, and undertook exploratory meta-regression. We assessed the certainty in evidence using GRADE framework and conducted trial sequential analysis. Fifty-nine systematic reviews met the inclusion criteria, from which five anchoring reviews were selected. Perioperative high fraction of inspired oxygen (Fio₂, 80%), compared with a low Fio₂ (30-35%), may reduce the incidence of SSI slightly (risk ratio [RR] 0.87, 95% confidence interval [CI] 0.76-1.01; risk difference [RD] 1.6% lower, 3% lower to 0.1% higher), but the evidence is very uncertain. High inspired oxygen may result in little to no difference in mortality (RR 1.17, 95% CI 0.77-1.78, RD 0.3% higher, 0.4% lower to 1.3% higher), based on low-certainty evidence. The evidence suggests that high Fio₂ results in a large increase in the incidence of atelectasis (RR 1.47, 95% CI 1.20-1.79, RD 6.5% higher, 2.8% higher to 10.9% higher, low-certainty evidence). Postoperative noninvasive ventilation (NIV) does not reduce mortality compared with conventional oxygen therapy (COT; RR 0.91, 95% CI 0.62-1.32, RD 0.1% lower, 0.6% lower to 0.5% higher), based on high-certainty evidence. Low-certainty evidence suggests that postoperative high-flow nasal oxygen (HFNO) compared with COT does not reduce mortality (RR 0.78, 95% CI 0.27-2.24, RD 0.4% lower, 1.4% lower to 2.4% higher). Low- to very low-certainty evidence indicates that postoperative NIV and HFNO may reduce some of the pulmonary adverse events compared with COT. Trial sequential analyses showed that further studies are required to determine which perioperative oxygen strategy is most clinically and cost effective. We did not find evidence to support routine use of high inspired oxygen to reduce surgical site infection and improve patient outcomes. A small reduction in surgical site infection associated with high Fio₂ cannot be ruled out and possible effect modifiers require further investigation. Existing evidence favours postoperative noninvasive ventilation and high-flow nasal oxygen over conventional oxygen therapy, but the low to very low certainty of evidence limits our confidence in the findings. PROSPERO CRD42021272361.

Background: Oxygen is routinely given to patients during and after surgery. Perioperative oxygen administration has been proposed as a potential strategy to prevent and treat hypoxaemia and reduce complications, such as surgical site infections, pulmonary complications and mortality. However, uncertainty exists as to which strategies in terms of amount, delivery devices and timing are clinically effective. The aim of this overview of systematic reviews and meta-analyses is to answer the research question, ‘For which types of surgery, at which stages of care, in which sub-groups of patients and delivered under what conditions are different types of perioperative oxygen therapy clinically effective?’. Methods: We will search key electronic databases (MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CENTRAL, Epistemonikos, PROSPERO, the INAHTA International HTA Database and DARE archives) for systematic reviews and randomised controlled trials comparing perioperative oxygen strategies. Each review will be mapped according to type of surgery, surgical pathway timepoints and clinical comparison. The highest quality reviews with the most comprehensive and up-to-date coverage of relevant literature will be chosen as anchoring reviews. Standardised data will be extracted from each chosen review, including definition of oxygen therapy, summaries of interventions and comparators, patient population, surgical characteristics and assessment of overall certainty of evidence. For clinical outcomes and adverse events, the overall pooled findings and results of subgroup and sensitivity analyses (where available) will be extracted. Trial-level data will be extracted for surgical site infections, mortality, and potential trial-level effect modifiers such as risk of bias, outcome definition and type of surgery to facilitate quantitative data analysis. This analysis will adopt a multiple indication review approach with panoramic meta-analysis using review-level data and meta-regression using trial-level data. An evidence map will be produced to summarise our findings and highlight any research gaps. Discussion: There is a need to provide a panoramic overview of systematic reviews and meta-analyses describing peri-operative oxygen practice to both inform clinical practice and identify areas of ongoing uncertainty, where further research may be required. Systematic review registration: PROSPERO CRD42021272361

Health checks aim to improve the health of the population by identifying individuals with risk factors earlier and intervening to prevent disease. The role of commissioners is to ensure health checks provide as much benefit as possible for taxpayer funds invested into them. As such, evidence of the potential impacts of different commissioning choices is beneficial in this decision-making process. System dynamics modelling can be used to provide this evidence by modelling the health check programme using a pre-existing cohort model of a given population. This modelling considers local data, literature findings, and stakeholder views, from which nine different scenarios of a local health check programme have been tested. These scenarios found that extending the duration of health checks to 20 years and improving treatment uptake for those with high blood pressure or high cholesterol reduced rates of cardiovascular disease, improved healthy life expectancy and reduced years lived in ill health. In contrast, improving attendance in the most deprived quintile of the population made very little change to the health of the population overall, although a larger effect was observed in the most deprived areas. These findings helped guide local commissioning decisions by showing the long-term impact of different health check scenarios.

England’s population is living longer, a sign of progress and better health, but adult social care (ASC) services must adapt to support a growing number of older residents, who may need help to remain independent, safe, and well. Kent County Council (KCC), in South East England, projects a 28% and 53% increase in its residents aged 65+ and 85+, respectively, over the next decade. This study aimed to inform the development of KCC’s ASC Prevention Framework using a System Dynamics Modelling (SDM) approach to evaluate the impact of preventive interventions on ASC demand and expenditure. Using linked local health and social care data and the Johns Hopkins ACG® tool, the 1.3 million adult population was stratified into Patient Needs Groups. Analyses showed that higher ASC costs were associated with being older females, living alone, deprivation, and frailty-related indicators such as dementia, history of falls, etc. Around 28% of older adults aged 65+ accounted for 80% of ASC costs within that cohort, and related scenario testing projected a 48% rise in ASC costs over 10 years without interventions, moderated to 33% with targeted prevention. These findings demonstrate the value of integrated data and modelling to inform strategic, prevention-focused ASC planning.