Can Preoperative Oral Care Reduce Complications From Cancer Surgery?

Undergoing oral care with a dentist prior to major cancer surgery significantly decreased postoperative complications, according to the results of a Japanese retrospective study. Patients who received oral care had lower rates of postoperative pneumonia and all-cause 30-day mortality.

“The question of whether preoperative oral care by a dentist can decrease postoperative complications remains controversial, because insufficient evidence has been provided in previous studies,” wrote Miho Ishimaru, of the School of Public Health at the University of Tokyo, and colleagues in the British Journal of Surgery. “The results of the present subgroup analyses indicated that preoperative oral care by a dentist was associated with a decrease in postoperative complications among patients who underwent esophageal, gastric, or colorectal cancer surgery.”

According to the study, pneumonia is a common and serious postoperative cancer surgery complication. The mouth can be a reservoir of respiratory pathogens, and removal of these pathogens may reduce complications. Current data are unclear on whether oral care by a dentist can reduce postoperative pneumonia and mortality. To study this further, Ishimaru and colleagues conducted this study using nationwide administrative claims that included more than a half million patients who underwent resection for head and neck, esophageal, gastric, colorectal, lung, or liver cancer from 2012–2015. 

Of the identified patients, 81,632 (16%) had received preoperative oral care from a dentist, and 15,724 (3.09%) had postoperative pneumonia. A small percentage (0.34%) died within 30 days of the cancer surgery.

Preoperative oral care from a dentist was more common in patients with esophageal cancer, those treated more recently, those who had a preoperative dental visit, those who were treated at a hospital with a lower volume, and those with dental cavities. Preoperative oral care from a dentist was less likely in patients with head and neck cancer.

The researchers adjusted for patient background, with inverse probability of treatment weighting (IPTW) using propensity scoring. Using IPTW, preoperative oral care from a dentist was associated with a significantly lower proportion of diagnoses of postoperative pneumonia (3.28% vs 3.76%; P < .001) and with a lower all-cause mortality at 30 days (0.30% vs 0.42%; P < .001).

Patients with esophageal, gastric, or colorectal cancer who had preoperative oral care from a dentist had significantly lower rates of postoperative pneumonia and all-cause mortality at 30 days.

“The involvement of dentists in the preoperative management of patients who are undergoing cancer surgery may be essential for decreasing postoperative complications,” concluded the researchers.