Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Biostatistics & Bioinformatics, The University of Tokyo, Tokyo, Japan.
Clin Oral Investig. 2019 Sep;23(9):3581-3588. doi: 10.1007/s00784-018-2783-5. Epub 2019 Jan 8.
Perioperative oral care was reported to decrease postoperative pneumonia after cancer resections. However, the effect remains controversial because previous studies were limited due to their small sample sizes and lack of strict control for patient backgrounds. The present study evaluated the association between perioperative oral care and postoperative pneumonia using high-dimensional propensity score (hd-PS) matching to adjust for confounding factors.
Using a Japanese health insurance claims database, we identified patients who underwent surgical treatment of cancer from April 2014 to March 2015. To compare outcomes (postoperative pneumonia and procedure-related complications) between patients with and without perioperative oral care, we performed hd-PS matching and conventional PS matching and chi-square test.
We identified 621 patients with oral care and 4374 patients without oral care. The occurrences of postoperative pneumonia were not significantly different between patients with and without oral care in the unmatched (2.9% vs. 3.2%), conventional PS-matched (2.9% vs. 2.9%), or hd-PS-matched (2.9% vs. 3.3%) groups. The occurrences of procedure-related complication were not significantly different between patients with and without oral care in the unmatched (23.8% vs. 24.5%), conventional PS-matched (23.8% vs. 26.4%), or hd-PS-matched (24.4% vs. 27.7%) groups.
There was no significant difference in postoperative pneumonia or procedure-related complications between patients with and without perioperative oral care.
While maintaining optimal oral care in cancer patients is an important goal, the present study revealed no significant difference in postoperative outcomes. Further investigations would be needed to determine the effect of perioperative oral care.
围手术期口腔护理被报道可降低癌症切除术后的术后肺炎发生率。然而，由于先前的研究由于样本量小且缺乏对患者背景的严格控制，其结果仍存在争议。本研究使用高维倾向评分（hd-PS）匹配来调整混杂因素，评估围手术期口腔护理与术后肺炎之间的关联。
使用日本健康保险索赔数据库，我们确定了 2014 年 4 月至 2015 年 3 月期间接受癌症手术治疗的患者。为了比较接受和未接受围手术期口腔护理的患者的结局（术后肺炎和与手术相关的并发症），我们进行了 hd-PS 匹配和传统 PS 匹配以及卡方检验。
我们确定了 621 例接受口腔护理的患者和 4374 例未接受口腔护理的患者。未匹配组（2.9%比 3.2%）、传统 PS 匹配组（2.9%比 2.9%）或 hd-PS 匹配组（2.9%比 3.3%）中，接受和未接受围手术期口腔护理的患者术后肺炎的发生率无显著差异。未匹配组（23.8%比 24.5%）、传统 PS 匹配组（23.8%比 26.4%）或 hd-PS 匹配组（24.4%比 27.7%）中，接受和未接受围手术期口腔护理的患者与手术相关的并发症发生率也无显著差异。
接受和未接受围手术期口腔护理的患者术后肺炎或与手术相关的并发症发生率无显著差异。
在癌症患者中保持最佳口腔护理是一个重要目标，但本研究显示术后结局无显著差异。需要进一步研究以确定围手术期口腔护理的效果。
