ABSTRACT

Zulfiqar A, Spindari K. Hyperbaric Oxygen Therapy Enhances Autologous Bone Graft Integration: A Meta-Analysis. Undersea Hyperb Med. 2025 Fourth Quarter; 52(4):549-564.

Background: Autologous bone grafting is crucial in reconstructive surgeries, yet high-risk patients often face challenges in achieving robust graft integration. Hyperbaric Oxygen Therapy (HBO2) has been proposed to improve graft outcomes by enhancing osteogenesis and vascularization. This systematic review and meta-analysis evaluated HBO2’s efficacy in promoting autologous bone graft integration and identified contexts in which HBO2may be most beneficial.

Methods: A systematic search identified 11 studies that met the inclusion criteria, of which seven provided quantitative data for meta-analysis. Random-effects models generated pooled Standardized Mean Differences (SMD) and assessed heterogeneity (I2). Subgroup analysis focused on orthopedic applications.

Results: Compared to control groups, HBO2 demonstrated a moderate to strong effect on bone graft integration in the primary analysis (SMD: 1.476, 95% CI: 0.814–2.138). However, heterogeneity was substantial (I2 ≈ 77%), reflecting diverse protocols and patient populations. A subgroup of orthopedic studies showed a stronger, consistent effect (SMD: 1.995, 95% CI: 1.117–2.873) with low heterogeneity (I2 = 3.361%). Although observational data suggest potential benefits in maxillofacial grafts, many studies in this domain are small or lack controls. One cranial study reported a negative result, indicating possible variability in craniofacial contexts.

Conclusions: HBO2 appears to substantially enhance autologous bone graft integration, particularly
in orthopedic and high-risk patients, by stimulating osteogenesis and vascularization. Nonetheless, reliance on animal models, limited human data in maxillofacial settings, and considerable heterogeneity underscore the need for further research, standardized protocols, and well-powered clinical trials to

confirm HBO2’s effectiveness across diverse grafting scenarios.
Keywords: autologous bone graft; bone integration; hyperbaric oxygen therapy; vascularization