Supplemental operating-room air purification did not reduce surgical infections in 107,000 operations

The edition in brief

ORACLE randomised 68 operating rooms in four-week blocks to active or identical sham supplemental air sterilisation, fully blinded, and analysed 107,334 operations. It stopped at the third interim analysis for futility: the 30-day composite of wound infection, infection-related complications or death was 8.1% versus 8.2% in inpatients (OR 0.98, 95% CI 0.92–1.05). Departments should not expect add-on air purifiers to lower infection; effort belongs on direct wound contamination. A Bayesian meta-analysis of 15 trials found protocolised intraoperative pressure targeting did not change mortality (OR 1.00) or myocardial injury, with an uncertain, fragile signal for acute kidney injury. In a multicentre trial in children under two, fistula after hypospadias repair was similar with caudal and penile blocks (8.9% vs 7.3%), and caudal blocks used less opioid, though the trial stopped early. In 258,624 Ontario arthroplasty patients, filling a new extended-release opioid was associated with slightly higher persistent opioid use, readmission and emergency visits. The pearl covers quantitative neuromuscular monitoring before extubation.