Department of Dentistry, Hiroshima Prefectural Hospital, Japan.
Department of Clinical Nutrition, Hiroshima Prefectural Hospital, Japan; Department of Gastroenterological, Breast, and Transplant Surgery, Hiroshima Prefectural Hospital, Japan.
Surgery. 2022 Aug;172(2):530-536. doi: 10.1016/j.surg.2022.02.015. Epub 2022 Apr 6.
Surgical site infection is a common postoperative complication of colorectal cancer surgery, and surgical site infection increases medical costs, prolongs hospitalization, and worsens long-term prognosis. Perioperative oral care has been reported to be effective in preventing postoperative pneumonia, although there are only a few reports on its effectiveness in preventing surgical site infection. This study aimed to determine the role of perioperative oral care in surgical site infection prevention after colorectal cancer surgery.
In this study, 1,926 patients with colorectal cancer from 8 institutions were enrolled; 808 patients (oral care group) received perioperative oral care at the hospital's dental clinic, and 1,118 (control group) did not receive perioperative oral care. The data were matched by propensity score to reduce bias. Ultimately, a total of 1,480 patients were included in the analysis.
The incidence of surgical site infection was significantly lower in the oral care group than in the control group (8.4% vs 15.7%, P < .001). Multivariate logistic regression analysis revealed 4 independent risk factors for surgical site infection: low albumin level, rectal cancer, blood loss, and lack of perioperative oral care. Lack of perioperative oral care had an odds ratio of 2.100 (95% confidence interval 1.510-2.930, P < .001).
These results suggest that perioperative oral care can reduce the incidence of surgical site infection after colorectal cancer resection. Perioperative oral care may have an important role in the future perioperative management of colorectal cancer as a safe and effective method of surgical site infection prevention, although further validation in prospective studies is needed.
手术部位感染是结直肠癌手术后常见的术后并发症,手术部位感染会增加医疗费用、延长住院时间,并恶化长期预后。有报道称,围手术期口腔护理可有效预防术后肺炎,尽管关于其预防手术部位感染的有效性的报道较少。本研究旨在确定围手术期口腔护理在预防结直肠癌手术后手术部位感染中的作用。
本研究纳入了来自 8 家机构的 1926 例结直肠癌患者;808 例患者(口腔护理组)在医院牙科诊所接受围手术期口腔护理,1118 例(对照组)未接受围手术期口腔护理。通过倾向评分匹配数据以减少偏倚。最终,共有 1480 例患者纳入分析。
口腔护理组的手术部位感染发生率明显低于对照组(8.4%比 15.7%,P<.001)。多变量逻辑回归分析显示,手术部位感染的 4 个独立危险因素为低白蛋白水平、直肠癌、出血量和缺乏围手术期口腔护理。缺乏围手术期口腔护理的优势比为 2.100(95%置信区间 1.510-2.930,P<.001)。
这些结果表明,围手术期口腔护理可降低结直肠癌切除术后手术部位感染的发生率。围手术期口腔护理可能在结直肠癌的未来围手术期管理中发挥重要作用,作为一种安全有效的预防手术部位感染的方法,尽管需要前瞻性研究进一步验证。