Treatment Outcomes of Adjuvant Hyperbaric Oxygen Therapy for Patients with Chronic Refractory Osteomyelitis

Charlotte Colt, BS, David Lindsie Cone, MD, Benjamin Jackson III, MD

With approximately 50,000 annual cases in the United Sates, osteomyelitis is a common cause of chronic, nonhealing wounds. Additionally, chronic refractory osteomyelitis (CRO) continues to be a difficult condition for orthopedic surgeons to successfully treat due to a high rate of recurrence after standard treatment with antibiotics and surgical debridement. The goals of treatment for this condition are to eliminate the infection while preserving function of the affected bone. Due to the effects of low tissue oxygen tension in osteomyelitic bone, researchers have suggested utilizing hyperbaric oxygen (HBO) as a treatment modality for CRO. HBO has been shown to be successful in several previous studies. However not all studies have supported the effectiveness of HBO on CRO. Regardless of the results of these studies, a common feature amongst the current literature is the call for more studies involving a larger population of patients. The purpose of this study is to examine patients at Prisma Health Midlands with CRO that were treated in the last ten years with HBO as an adjunct to standard therapy. Patients over 18 years old with CRO treated adjunctively with HBO were retrospectively reviewed. Our primary research aim is to evaluate any significant association between adjunctive HBO therapy and positive treatment outcomes in patients with CRO. A secondary goal of this study is to analyze cases in which HBO therapy was not effective, to determine potential predictive factors for HBO treatment failure. Summary statistics will be provided, and a repeated measures ANOVA model will be implemented to determine statistical significance in support of the hypothesis. Additionally, a synthetic control model will be performed. Survival analysis will evaluate predictive factors of HBO treatment failure. We expect HBO treatment will be associated with a statistically significant increase in rates of positive treatment outcomes for patients with CRO. Thus, we hypothesize the use of adjuvant HBO will be an effective addition to the standard treatment regimen. The findings in this study will serve to enhance our current understanding of these treatment mechanisms and their expected synergistic effects with the goal of improving rates of successful treatment for CRO. Furthermore, identification of any predictive factors for HBO treatment failure in addition to future studies examining the relative efficacy of different antibiotics used in conjunction with HBO, may further aid our understanding of the most effective treatment for CRO.