Oral Management Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Support Care Cancer. 2020 Sep;28(9):4155-4162. doi: 10.1007/s00520-019-05242-w. Epub 2020 Jan 2.
Postoperative pneumonia is one of the major complications after esophageal cancer surgery. The risk factors associated with postoperative pneumonia are poor general health, smoking, decreased pulmonary function, diabetes mellitus, surgical stress, old age, postoperative aspiration, and oral hygiene. In this study, we examined the effect of perioperative oral care on reducing postoperative pneumonia since the evidence to-date is not clear.
A multicenter, retrospective investigation of the relationship between perioperative oral care and incidence of postoperative pneumonia in patients undergoing esophageal cancer surgery was conducted. A total of 775 patients who underwent thoracoscopic esophageal resection at 25 hospitals between 2016 and 2017 were enrolled in the study. Various factors were examined for correlation with development of postoperative pneumonia.
Multivariate analysis showed that old age, smoking habit, lower hemoglobin, higher creatinine, postoperative dysphagia, and lack of oral care intervention were independent risk factors for pneumonia. Oral care was more effective in preventing pneumonia in hospitals in which the incidence of postoperative pneumonia was lower than 20%, while it was not effective in hospitals in which the incidence was higher than 20%.
Results of the study suggest that it is recommended to carry out perioperative oral care in esophageal cancer surgery.
术后肺炎是食管癌手术后的主要并发症之一。与术后肺炎相关的危险因素包括一般健康状况差、吸烟、肺功能下降、糖尿病、手术应激、年龄较大、术后误吸和口腔卫生不良。在本研究中，我们研究了围手术期口腔护理对降低食管癌手术后肺炎发生率的影响，因为目前的证据尚不清楚。
对 2016 年至 2017 年间 25 家医院接受胸腔镜食管切除术的 775 例患者进行了围手术期口腔护理与术后肺炎发生率之间关系的多中心回顾性调查。检查了各种因素与术后肺炎发展的相关性。
多因素分析显示，年龄较大、吸烟习惯、血红蛋白较低、肌酐较高、术后吞咽困难和缺乏口腔护理干预是肺炎的独立危险因素。口腔护理在术后肺炎发生率低于 20%的医院中更有效，而在术后肺炎发生率高于 20%的医院中则无效。
研究结果表明，建议在食管癌手术中进行围手术期口腔护理。
