Surgery places significant physiological stress on the body.  From tissue trauma and inflammation to reduced oxygen delivery at the cellular level, recovery is often limited by how well the body can heal.

Hyperbaric Oxygen Therapy (HBOT) is increasingly being explored as a pre- and post-surgical adjunct to optimise healing, reduce complications, and enhance recovery.

But what does the research actually say?

HBOT involves breathing highly-concentrated oxygen under pressure, significantly increasing the amount of oxygen dissolved in the blood plasma.  This allows oxygen to reach hypoxic (low oxygen) tissues, which are common after surgery.

Research shows HBOT can:

• Increase tissue oxygenation

• Stimulate new blood vessel formation (angiogenesis)

• Enhance immune function

• Support collagen production and wound healing

(Hyperbaric Oxygen Therapy in Modern Surgical Practice: Mechanistic Basis and Clinical Applications Across Specialties; Flores et al, 2026), (Advances in Hyperbaric Oxygen Therapy: Medical Benefits and Technical Perspectives; Naaji et al, 2006)

These mechanisms directly target the key limitations of surgical recovery: poor oxygen supply, inflammation, and infection risk.

Benefits of HBOT Before Surgery (Preconditioning)

Using HBOT prior to surgery is often referred to as 'preconditioning'.  The goal is to prepare tissues to better tolerate surgical stress.

Preoperative HBOT increases oxygen availability in tissues, helping them better withstand surgical trauma and reduces blood flow during procedures.  Studies show improved oxygen delivery can support cellular metabolism and tissue survival.

Emerging evidence suggests pre-surgical HBOT may reduce complications such as infection, wound breakdown, and delayed healing.  Multiple cohort studies and trials report lower postoperative complication rates and reduced ICU stays when HBOT is used preoperatively.  (The Effects of Hyperbaric Oxygenation on Oxidative Stress, Inflammation and Angiogenesis;  De Wolde et al, 2021)

HBOT stimulates angiogenesis, meaning tissues enter surgery with a stronger microvascular network.  This is particularly relevant for:

• Plastic and reconstructive surgery

• Orthopaedic procedures

• Radiation-damaged tissues

Benefits of HBOT After Surgery (Recovery Phase)

Postoperative HBOT is where the bulk of clinical use currently sits.

HBOT enhances fibroblast activity and collagen formation - both essential for tissue repair.  Evidence shows improved wound healing, graft survival, and flap viability.  (Hyperbaric Oxygen Therapy in Modern Surgical Practice:  Mechanistic Basis and Clinical Applications Across Specialties; Flores et al, 2006), (Effectiveness of Hyperbaric Oxygen Treatment in Facial Plastic and Reconstructive Surgery: A Systematic Review; Meyer et al, 2025).

Surgery triggers inflammatory cascades that can delay recovery.  HBOT has been shown to reduce inflammatory markers and modulate oxidative stress pathways. (The Effects of Hyperbaric Oxygenation on Oxidative Stress, Inflammation and Angiogenesis; De Wolde et al, 2021).

A randomised controlled trial in knee surgery patients found HBOT reduced postoperative muscle damage and inflammation markers.  (Effect of Hyperbaric Oxygen Therapy on Postoperative Muscle Damage and Inflammation Following Total Knee Arthroplasty: a Randomised Controlled Trial; Zhang et al, 2025).

Oxygen plays a key role in immune function.  HBOT enhances leukocyte (white blood cell) activity and has bacteriostatic and bactericidal effects.  This is particularly important in:

• Orthopaedic surgery

• Implant-based procedures

• Compromised or irradiated tissue

HBOT appears especially valuable in patients with diabetes, vascular disease, and previous radiation therapy.  For example, a study on breast reconstruction after radiation showed a lower risk of complications in patients receiving perioperative HBOT despite having more severe baseline tissue damage.  (Perioperative Hyperbaric Oxygen Treatment and Postoperative Complications Following Secondary Breast Reconstruction After Radiotherapy: a Case-Control Study of 45 Patients;  Meier et al, 2021).

HBOT fits best as an adjunct therapy for:

• Elective surgery (pre-conditioning and recovery optimisation)

• Cosmetic and reconstructive procedures

• Orthopaedic surgery

• Chronic or slow-healing wounds

• Post-radiation tissue repair

Key Takeaway

HBOT addresses one of the most overlooked factors in surgical recovery:  oxygen delivery at the tissue level.  The research suggests that when used appropriately before surgery it may prepare tissues and reduce complications, and after surgery it can accelerate healing and improve outcomes.

As interest in optimisation and recovery grows - particularly in sports, orthopaedics, and elective procedures - HBOT is becoming an increasingly valuable tool in modern perioperative care.

- Samantha Winters