TY - JOUR
T1 - Impact of Dental Referral Prior to Elective Surgery on Postoperative Outcomes
AU - Suenaga, Hanako
AU - Aida, Jun
AU - Kumasaka, Akira
AU - Shibamoto, Aya
AU - Sato, Satoko
AU - Shinohara, Yuta
AU - Hatakeyama, Takenori
AU - Yamaguchi, Hirofumi
AU - Sasaki, Keiichi
AU - Takahashi, Tetsu
AU - Koseki, Takeyoshi
AU - Peck, Chris
AU - Iikubo, Masahiro
N1 - Funding Information:
We thank the medical information technology center at the Tohoku University Hospital and Dr. Chiaki Satoh for their support in collecting the data.
Publisher Copyright:
© 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
KW - Postoperative complications
KW - health care costs
KW - hospital stay
KW - preoperative dental care
KW - preoperative dental referral
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U2 - 10.1016/j.jamda.2022.01.071
DO - 10.1016/j.jamda.2022.01.071
M3 - Article
C2 - 35219603
AN - SCOPUS:85126788827
SN - 1525-8610
VL - 23
SP - 638-645.e2
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 4
ER -
