Division of Thoracic Surgery, Department of Surgery, University of Alberta, 416 Community Services Centre, 10240 Kingsway Ave, Edmonton, T5H 3V9, AB, Canada.
John W. Scott Health Sciences Library, University of Alberta, Edmonton, T5H 3V9, Canada.
Langenbecks Arch Surg. 2023 May 24;408(1):209. doi: 10.1007/s00423-023-02936-y.
Post-operative pneumonia after esophagectomy is a major contributor to morbidity and mortality. Prior studies have demonstrated a link between the presence of pathologic oral flora and the development of aspiration pneumonia. The objective of this systematic review and meta-analysis was to evaluate the effect of pre-operative oral care on the incidence of post-operative pneumonia after esophagectomy.
A systematic search of the literature was performed on September 2, 2022. Screening of titles and abstracts, full-text articles, and evaluation of methodological quality was performed by two authors. Case reports, conference proceedings, and animal studies were excluded. A meta-analysis of peri-operative oral care on the odds of post-operative pneumonia after esophagectomy was performed using Revman 5.4.1 with a Mantel-Haenszel, random-effects model.
A total of 736 records underwent title and abstract screening, leading to 28 full-text studies evaluated for eligibility. A total of nine studies met the inclusion criteria and underwent meta-analysis. Meta-analysis revealed a significant reduction in post-operative pneumonia among patients undergoing pre-operative oral care intervention compared to those without an oral care intervention (OR 0.57, 95% CI 0.43-0.74, p < 0.0001; I = 49%).
Pre-operative oral care interventions have significant potential in the reduction of post-operative pneumonia after esophagectomy. North American prospective studies, as well as studies on the cost-benefit analysis, are required.
食管癌手术后肺炎是发病率和死亡率的主要原因。先前的研究表明，口腔菌群的存在与吸入性肺炎的发生之间存在关联。本系统评价和荟萃分析的目的是评估术前口腔护理对食管癌术后肺炎发生率的影响。
于 2022 年 9 月 2 日对文献进行系统检索。两名作者对标题和摘要、全文文章进行筛选，并评估方法学质量。排除病例报告、会议记录和动物研究。使用 Revman 5.4.1 采用 Mantel-Haenszel、随机效应模型对围手术期口腔护理对食管癌术后肺炎发生的几率进行荟萃分析。
共筛选出 736 条记录，其中 28 篇全文研究进行了资格评估。共有 9 项研究符合纳入标准并进行了荟萃分析。荟萃分析显示，与未进行口腔护理干预的患者相比，接受术前口腔护理干预的患者术后肺炎发生率显著降低（OR 0.57，95%CI 0.43-0.74，p < 0.0001；I = 49%）。
术前口腔护理干预在降低食管癌术后肺炎方面具有显著潜力。需要开展北美前瞻性研究以及成本效益分析研究。
