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Prevention of postoperative pneumonia by perioperative oral care in patients with esophageal cancer undergoing surgery: a multicenter retrospective study of 775 patients

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Abstract

Purpose

Postoperative pneumonia is one of the major complications after esophageal cancer surgery. The risk factors associated with postoperative pneumonia are poor general health, smoking, decreased pulmonary function, diabetes mellitus, surgical stress, old age, postoperative aspiration, and oral hygiene. In this study, we examined the effect of perioperative oral care on reducing postoperative pneumonia since the evidence to-date is not clear.

Methods

A multicenter, retrospective investigation of the relationship between perioperative oral care and incidence of postoperative pneumonia in patients undergoing esophageal cancer surgery was conducted. A total of 775 patients who underwent thoracoscopic esophageal resection at 25 hospitals between 2016 and 2017 were enrolled in the study. Various factors were examined for correlation with development of postoperative pneumonia.

Results

Multivariate analysis showed that old age, smoking habit, lower hemoglobin, higher creatinine, postoperative dysphagia, and lack of oral care intervention were independent risk factors for pneumonia. Oral care was more effective in preventing pneumonia in hospitals in which the incidence of postoperative pneumonia was lower than 20%, while it was not effective in hospitals in which the incidence was higher than 20%.

Conclusion

Results of the study suggest that it is recommended to carry out perioperative oral care in esophageal cancer surgery.

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Acknowledgments

We thank the following collaborators for collecting data: Jun-ya Kogami (Asahikawa Medical University Hospital), Kouichi Sawaki (Hiroshima City Hospital), Hiroshi Nobuhara (Hiroshima Prefectural Hospital), Sinsho Tachibana (Kakogawa Central City Hospital), Yuka Kojima (Kansai Medical University Hospital), Minoru Kubota (Kurashiki Central Hospital), Sonoe Baba (Miyazaki University Hospital), Chika Yamauchi (Nagoya City University Hospital), Keiichiro Ono (National Hospital Organization Beppu Medical Center), Masashi Morioka (Shinshu University Hospital), Yuka Yamaguchi (Toho University Medical Center Omori Hospital), Toshihiro Yamauchi (Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital), Chie Nakajo (Toyama Prefectural Central Hospital), Kei Tomihara (Toyama University Hospital), Toshiro Yamamoto (University Hospital Kyoto Prefectural University of Medicine), and Iku Yamamori (Yamagata University Hospital). We thank Editage (www.editage.jp) for their English-language editing services.

Author information

Authors and Affiliations

  1. Oral Management Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan

    Sakiko Soutome

  2. Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Takumi Hasegawa

  3. Department of Preventive Dentistry, Research Field in Dentistry, Medical and Dental Sciences Area, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan

    Taihei Yamguchi

  4. Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan

    Kumiko Aoki

  5. Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan

    Naritomo Kanamura

  6. Department of Oral Maxillofacial Surgery, Kindai University Hospital, 337-2 Ono-higashi, Sayama, Osaka, 589-8511, Japan

    Takao Mukai

  7. Perioperative Oral Care Center and Division of General Oral Care, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-0054, Japan

    Junichi Yamazoe

  8. Department of Oral and Maxillofacial Surgery, and Division of Tissue Engineering Graduate School of Medicine, Nagoya University Graduate School of Medicine, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan

    Masaya Nishikawa

  9. Unit of Dentistry and First Department of Oral and Maxillofacial Surgery, Osaka University Hospital, Graduate School of Dentistry, Osaka University, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Emiko Isomura

  10. Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kazuto Hoshi

  11. Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan

    Masahiro Umeda

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  1. Sakiko Soutome
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  2. Takumi Hasegawa
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Consortia

Joint Research Committee of Japanese Society of Oral Care

Corresponding author

Correspondence to Sakiko Soutome.

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The authors declare that they have no conflicts of interest.

Ethical approval and informed consent

This study was performed in accordance with the 1964 Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Boards (IRB) of each participating hospital. As this was a retrospective study, the research plan was published on the homepage of the participating hospitals according to the instructions of the IRB in accordance with the guaranteed opt-out opportunity.

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Soutome, S., Hasegawa, T., Yamguchi, T. et al. 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 28, 4155–4162 (2020). https://doi.org/10.1007/s00520-019-05242-w

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