Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Koriyama, Japan.
Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
Int J Clin Oncol. 2019 Dec;24(12):1558-1564. doi: 10.1007/s10147-019-01513-y. Epub 2019 Jul 22.
The effectiveness of perioperative oral management in gastrointestinal surgery remains unclear. To elucidate the clinical significance of oral care, we investigated the relationship between the oral environment and postoperative infectious complications (POICs) in patients undergoing gastrointestinal surgery.
This was a single-institute and historical cohort study of 341 patients. The participants were isolated from consecutive patients undergoing planned radical resection for gastrointestinal carcinoma from January 2016 to June 2017. Dentists assessed the oral environment for periodontal disease, hygiene status, dry mouth, fur on tongue, and tooth stumps. All patients received scaling and tooth brushing instructions. A stepwise logistic regression analysis was conducted to identify risk factors for POICs among the different oral statuses.
The surgical procedures performed were gastrectomy in 123 (36.1%), colorectal resection in 185 (54.2%), and pancreatoduodenectomy or others in 38 (11.1%). POICs occurred in 48 patients (14.1%), including deep organ space infection in 20, surgical site infection in 11, anastomotic leakage in 5, urinary tract infection in 4, pneumonia in 2, and others in 6. After adjusting for confounding factors, periodontal disease was isolated as an independent risk factor for POICs (odds ratio 2.091, p = 0.037, 95% confidence interval 1.045-4.183). Other variables of oral environment such as hygiene status, dry mouth, fur on tongue, and tooth stumps did not have a significant impact on POICs.
Periodontal disease is a risk factor for infectious complications after gastrointestinal surgery.
围手术期口腔管理在胃肠外科中的有效性仍不清楚。为了阐明口腔护理的临床意义，我们研究了胃肠道手术患者的口腔环境与术后感染性并发症（POIC）之间的关系。
这是一项单中心、历史性队列研究，纳入了 341 例患者。这些患者均为 2016 年 1 月至 2017 年 6 月期间连续接受胃肠癌根治性切除术的患者。牙医评估了牙周病、卫生状况、口干、舌苔和残根的口腔环境。所有患者均接受了洁牙和刷牙指导。采用逐步逻辑回归分析确定不同口腔状况下 POIC 的危险因素。
手术方式包括胃切除术 123 例（36.1%）、结直肠切除术 185 例（54.2%）和胰十二指肠切除术或其他手术 38 例（11.1%）。48 例患者发生 POIC（14.1%），包括深部器官间隙感染 20 例、手术部位感染 11 例、吻合口漏 5 例、尿路感染 4 例、肺炎 2 例和其他 6 例。调整混杂因素后，牙周病被单独列为 POIC 的独立危险因素（比值比 2.091，p=0.037，95%置信区间 1.045-4.183）。其他口腔环境变量，如卫生状况、口干、舌苔和残根，对 POIC 无显著影响。
牙周病是胃肠手术后感染性并发症的危险因素。
