A Systematic Review of Preoperative Oral Health Intervention in Abdominal Surgery Patients

Author(s):
Chelsea Guy-Frank; James Klugh; Naila Dhanani; Jonah Stulberg; Charles Wade; Lillian Kao

Background:

Poor oral health is an underrecognized risk factor for postoperative complications. Previous studies have demonstrated reduced postoperative complications with bundle care that includes oral hygiene. A systematic review was conducted to examine the effects of preoperative oral health on postoperative infectious outcomes in abdominal surgery patients.

Hypothesis:

Preoperative oral health intervention is associated with a reduction in postoperative infectious complications in abdominal surgery patients.

Methods:

A literature search was conducted of MEDLINE, Embase and Cochrane from inception to October 2021. Randomized control trials (RCT) and observational studies (ObS), which assessed adult patients undergoing abdominal surgery and receiving preoperative oral/dental care were included. Risk of bias was assessed with CASP and quality of evidence was evaluated with GRADE.

Results:

Eleven studies met inclusion criteria: 1 RCT and 10 ObS, the majority were from Japan. Outcomes included pneumonia (PNA), surgical site infections (SSI) and postoperative infectious complications. Preoperative oral management (POM) with dental care reduced PNA, SSI, and infectious complications; and >2 visits, with initial visit >2 weeks preoperatively, was associated with a dose response reduction of infections. Additionally, severe periodontal disease/plaque score was associated with increased risk of infectious outcomes.

Conclusions:

Perioperative oral hygiene was associated with reduced infectious complications after abdominal surgeries. Although the quality of evidence was low, perioperative oral hygiene is a low-cost intervention that warrants investigation in further prospective studies.