Advertisement

Perioperative oral care can prevent surgical site infection after colorectal cancer surgery: A multicenter, retrospective study of 1,926 cases analyzed by propensity score matching

Published:April 06, 2022DOI:https://doi.org/10.1016/j.surg.2022.02.015

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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).

      Conclusion

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ladabaum U.
        • Dominitz J.A.
        • Kahi C.
        • Schoen R.E.
        Strategies for colorectal cancer screening.
        Gastroenterology. 2020; 158: 418-432
        • Kuipers E.J.
        • Grady W.M.
        • Lieberman D.
        • et al.
        Colorectal cancer.
        Nat Rev Dis Primers. 2015; 115065
        • Leaper D.J.
        • Holy C.E.
        • Spencer M.
        • et al.
        Assessment of the risk and economic burden of surgical site infection following colorectal surgery using a US longitudinal database: is there a role for innovative antimicrobial wound closure technology to reduce the risk of infection?.
        Dis Colon Rectum. 2020; 63: 1628-1638
        • Ban K.A.
        • Minei J.P.
        • Laronga C.
        • Harbrecht B.G.
        • Jensen E.H.
        • Fry D.E.
        • et al.
        American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update.
        J Am Coll Surg. 2017; 224: 59-74
        • Kim I.Y.
        • Kim B.R.
        • Kim Y.W.
        Factors affecting use and delay (≥8 weeks) of adjuvant chemotherapy after colorectal cancer surgery and the impact of chemotherapy-use and delay on oncologic outcomes.
        PLOS One. 2015; 10e0138720
        • Miyamoto Y.
        • Hiyoshi Y.
        • Tokunaga R.
        • et al.
        Postoperative complications are associated with poor survival outcome after curative resection for colorectal cancer: a propensity-score analysis.
        J Surg Oncol. 2020; 122: 344-349
        • Cienfuegos J.A.
        • Baixauli J.
        • Beorlegui C.
        • et al.
        The impact of major postoperative complications on long-term outcomes following curative resection of colon cancer.
        Int J Surg. 2018; 52: 303-308
        • Lawler J.
        • Choynowski M.
        • Bailey K.
        • Bucholc M.
        • Johnston A.
        • Sugrue M.
        Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery.
        BJS Open. 2020; 4: 737-747
        • Todd B.
        New CDC guideline for the prevention of surgical site infection.
        Am J Nurs. 2017; 117: 17
        • Allegranzi B.
        • Bischoff P.
        • de Jonge S.
        • et al.
        WHO Guidelines Development Group. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective.
        Lancet Infect Dis. 2016; 16: e276-e287
        • Anderson D.J.
        • Podgorny K.
        • Berríos-Torres S.I.
        • et al.
        Strategies to prevent surgical site infections in acute care hospitals: 2014 update.
        Infect Control Hosp Epidemiol. 2014; 35: 605-627
        • Soutome S.
        • Hasegawa T.
        • Yamguchi T.
        • et al.
        Joint Research Committee of Japanese Society of Oral Care. Prevention of postoperative pneumonia by perioperative oral care in patients with esophageal cancer undergoing surgery: a multicenter retrospective study of 775 patients.
        Support Care Cancer. 2020; 28: 4155-4162
        • Iwata E.
        • Hasegawa T.
        • Yamada S.I.
        • et al.
        Effects of perioperative oral care on prevention of postoperative pneumonia after lung resection: multicenter retrospective study with propensity score matching analysis.
        Surgery. 2019; 165: 1003-1007
        • Ishimaru M.
        • Matsui H.
        • Ono S.
        • Hagiwara Y.
        • Morita K.
        • Yasunaga H.
        Preoperative oral care and effect on postoperative complications after major cancer surgery.
        Br J Surg. 2018; 105: 1688-1696
        • Kurasawa Y.
        • Maruoka Y.
        • Sekiya H.
        • et al.
        Pneumonia prevention effects of perioperative oral management in approximately 25,000 patients following cancer surgery.
        Clin Exp Dent Res. 2020; 6: 165-1673
        • Sato J.
        • Goto J.
        • Harahashi A.
        • et al.
        Oral Health care reduces the risk of postoperative surgical site infection in inpatients with oral squamous cell carcinoma.
        Support Care Cancer. 2011; 19: 409-416
        • Nobuhara H.
        • Yanamoto S.
        • Funahara M.
        • et al.
        Effect of perioperative oral management on the prevention of surgical site infection after colorectal cancer surgery: a multicenter retrospective analysis of 698 patients via analysis of covariance using propensity score.
        Med (Baltim). 2018; 97: e12545
        • Hasegawa T.
        • Takeda D.
        • Tanaka M.
        • et al.
        Effects of preoperative dental examination and oral hygiene instruction on surgical site infection after hepatectomy: a retrospective study.
        Support Care Cancer. 2021; 29: 653-659
        • Mangram A.J.
        • Horan T.C.
        • Pearson M.L.
        • Silver L.C.
        • Jarvis W.R.
        Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) hospital infection control practices advisory committee.
        Am J Infect Control. 1999; 27 (quiz 3–4; discussion 96): 97-132
        • Solomkin J.S.
        • Mazuski J.
        • Blanchard J.C.
        • et al.
        Introduction to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee guideline for the prevention of surgical site infections.
        Surg Infect (Larchmt). 2017; 18: 385-393
        • Normand S.T.
        • Landrum M.B.
        • Guadagnoli E.
        • et al.
        Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores.
        J Clin Epidemiol. 2001; 54: 387-398https://doi.org/10.1016/s0895-4356(00)00321-8
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Larson D.W.
        • Abd El Aziz M.A.
        • Perry W.
        • et al.
        Additional value of preoperative albumin for surgical risk stratification among colorectal cancer patients.
        Ann Nutr Metab. 2020; 76: 422-430
        • Hiratsuka T.
        • Inomata M.
        • Akagi T.
        • et al.
        Identification of surgical site infection risk factors in the digestive surgery by analysis based on surgical site infection surveillance.
        Jpn J Gastroenterol Surg Nihon Shokaki Geka Gakkai zasshi. 2016; 49: 1191-1198
        • Gomila A.
        • Carratalà J.
        • Camprubí D.
        • et al.
        VINCat Colon Surgery Group. Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery.
        Antimicrob Resist Infect Control. 2017; 6: 40
        • Ikeda A.
        • Fukunaga Y.
        • Akiyoshi T.
        • et al.
        Wound infection in colorectal cancer resections through a laparoscopic approach: a single-center prospective observational study of over 3000 cases.
        Discov Oncol. 2021; 12: 2
        • Miki C.
        • Inoue Y.
        • Mohri Y.
        • Kobayashi M.
        • Kusunoki M.
        Site-specific patterns of surgical site infections and their early indicators after elective colorectal cancer surgery.
        Dis Colon Rectum. 2006; 49: S45-S52
        • Geerts S.O.
        • Nys M.
        • De M.P.
        • et al.
        Systemic release of endotoxins induced by gentle mastication: association with periodontitis severity.
        J Periodontol. 2002; 73: 73-78
        • Amodini Rajakaruna G.
        • Umeda M.
        • Uchida K.
        • et al.
        Possible translocation of periodontal pathogens into the lymph nodes draining the oral cavity.
        J Microbiol. 2012; 50: 827-836
        • Gholizadeh P.
        • Eslami H.
        • Kafil H.S.
        Carcinogenesis mechanisms of Fusobacterium nucleatum.
        Biomed Pharmacother. 2017; 89: 918-925
        • Komiya Y.
        • Shimomura Y.
        • Higurashi T.
        • et al.
        Patients with colorectal cancer have identical strains of Fusobacterium nucleatum in their colorectal cancer and oral cavity.
        Gut. 2019; 68: 1335-1337
        • Yen A.M.
        • Lai H.
        • Fann J.C.
        • Chiu S.Y.
        • Chen S.L.
        Relationship between community periodontal index and fecal hemoglobin concentration, an indicator for colorectal neoplasm.
        J Dent Res. 2014; 93: 760-766
        • Rickard A.H.
        • Gilbert P.
        • High N.J.
        • Kolenbrander P.E.
        • Handley P.S.
        Bacterial coaggregation: an integral process in the development of multi-species biofilms.
        Trends Microbiol. 2003; 11: 94-100
        • Lourenςo T.G.B.
        • Spencer S.J.
        • Alm E.J.
        • Colombo A.P.V.
        Defining the gut microbiota in individuals with periodontal diseases: an exploratory study.
        J Oral Microbiol. 2018; 101487741
        • Nakajima M.
        • Arimatsu K.
        • Kato T.
        • et al.
        Oral administration of P gingivalis induces dysbiosis of gut microbiota and impaired barrier function leading to dissemination of enterobacteria to the liver.
        PLOS One. 2015; 10e0134234
        • Alverdy J.C.
        • Hyman N.
        • Gilbert J.
        Re-examining causes of surgical site infections following elective surgery in the era of asepsis.
        Lancet Infect Dis. 2020; 20: e38-e43
        • Eke P.I.
        • Borgnakke W.S.
        • Genco R.J.
        Recent epidemiologic trends in periodontitis in the USA.
        Periodontol. 2000; (2020;82:257–267)