Impact of Dental Referral Prior to Elective Surgery on Postoperative Outcomes

Hanako Suenaga, Jun Aida, Akira Kumasaka, Aya Shibamoto, Satoko Sato, Yuta Shinohara, Takenori Hatakeyama, Hirofumi Yamaguchi, Keiichi Sasaki, Tetsu Takahashi, Takeyoshi Koseki, Chris Peck, Masahiro Iikubo

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Objectives: Oral bacteria may contribute to postoperative infectious complications including postoperative pneumonia or surgical site infection. The aim of this study was to investigate the impact of preoperative dental care on postoperative outcomes among surgical patients under general anesthesia. Design: Retrospective cohort study. Setting and Participants: We analyzed clinical records of major surgical patients at a university hospital between 2016 and 2018. Subjects were categorized into either the preoperative dental care group, those being referred to dentists by their surgeons based on an individual surgeon's judgment for dental care before surgery, or the control group. Methods: The primary outcome was postoperative infectious complications. Secondary outcomes were postoperative inflammation markers (C-reactive protein and fever), and economic outcomes (postoperative length of hospital stay and medical expenses). As the main analysis, the average treatment effects of the preoperative dental care were obtained from the augmented inverse-probability weighting (AIPW) method with consideration of demographics and perioperative risk factors to estimate causal effect of the intervention from the observational data. Then, stratified analyses by age and surgical sites were conducted with the inverse-probability weighting and linear regression methods, respectively. Results: In the AIPW estimation, compared with the control group, the care group saw a significantly lower rate of postoperative infection (average treatment effect −3.02) and shorter fever duration (−2.79 days). The stratified analysis by age revealed significant positive impact of dental care in all age groups, including the highest treatment effects observed among patients younger than 60. Also, treatment effect was observed in wider surgical sites than previously known. Conclusion/Implications: This study indicates a significant impact of preoperative dental care on preventing postoperative infection and inflammation. Along with old age or certain types of surgeries in which advantages of dental referral have been already known, preoperative dental referral could be beneficial for broader types of patients.

Original languageEnglish
Pages (from-to)638-645.e2
JournalJournal of the American Medical Directors Association
Issue number4
Publication statusPublished - 2022 Apr


  • Postoperative complications
  • health care costs
  • hospital stay
  • preoperative dental care
  • preoperative dental referral

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology


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