Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan; Department of Nursing, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
Division of Health Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
Auris Nasus Larynx. 2020 Aug;47(4):643-649. doi: 10.1016/j.anl.2020.01.001. Epub 2020 Feb 7.
This study aimed to investigate the incidence of postoperative pneumonia (PP) and surgical site infection (SSI) in head and neck cancer (HNC) patients and clarify the relationship between oral care and postoperative infection.
We conducted a retrospective observation survey based on the medical records of 209 HNC surgery patients managed at a University Hospital in 2016-2018. The incidence of PP and SSI were assessed in patients who underwent operations of the nose and paranasal sinuses to the larynx. Factors associated with PP and SSI in a univariate analysis were included in a multiple logistic regression analysis. A Cox proportional hazards model was used analyze the incidence of PP according to time after surgery. The present study was approved by the ethical review board of our Institute.
The rates of PP and SSI in our study population were 20.5% and 23.0%. Operative time (P < 0.01), blood loss (P = 0.004), tracheostomy (P < 0.01), reconstruction (P < 0.01), and preoperative plaque control record (PCR) (P < 0.01) were significantly associated with PP. The PCR depicted the oral hygiene based on the percentage of plaque attached to the tooth neck. A multiple logistic regression analysis indicated that the incidence of PP was significantly higher in patients with PCR values of ≥50% after preoperative oral care (OR=10.174, 95% CI 2.14-48.32, P = 0.004). Tracheostomy (P < 0.01), reconstruction (P = 0.044), a lower preoperative albumin level (P = 0.019), and a lower preoperative hemoglobin level (P < 0.01) were significantly associated with SSI.
The incidence of PP among patients who received oral care was high in those patients with high PCR values, indicating the importance of increasing compliance to preoperative oral care.
本研究旨在调查头颈部癌症（HNC）患者术后肺炎（PP）和手术部位感染（SSI）的发生率，并阐明口腔护理与术后感染之间的关系。
我们对 2016 年至 2018 年期间在一所大学医院接受手术的 209 例 HNC 患者的病历进行了回顾性观察调查。评估了接受鼻和鼻窦至喉部手术的患者的 PP 和 SSI 发生率。在单变量分析中与 PP 和 SSI 相关的因素被纳入多变量逻辑回归分析。使用 Cox 比例风险模型根据手术后时间分析 PP 的发生率。本研究经我院伦理审查委员会批准。
本研究人群的 PP 和 SSI 发生率分别为 20.5%和 23.0%。手术时间（P<0.01）、出血量（P=0.004）、气管切开术（P<0.01）、重建（P<0.01）和术前菌斑控制记录（PCR）（P<0.01）与 PP 显著相关。PCR 根据牙颈部附着的菌斑百分比来描述口腔卫生状况。多变量逻辑回归分析表明，术前口腔护理后 PCR 值≥50%的患者发生 PP 的发生率显著更高（OR=10.174，95%CI 2.14-48.32，P=0.004）。气管切开术（P<0.01）、重建（P=0.044）、术前白蛋白水平较低（P=0.019）和术前血红蛋白水平较低（P<0.01）与 SSI 显著相关。
接受口腔护理的患者中，PCR 值较高的患者发生 PP 的发生率较高，表明增加对术前口腔护理的依从性非常重要。
