Association of Postoperative C-Reactive Protein with Use of Cetylpyridinium Chloride in Perioperative Oral Management: Sub-analysis of a Mouthwash Intervention Study

Abstract

Purpose Perioperative oral management (POM) reduces the risk of postoperative complications. We previously conducted a randomized controlled feasibility study using povidone iodine (PVP-I) or 0.05% cetylpyridinium chloride (CPC) in POM and found that perioperative self-care with CPC product may support antibiotic-induced changes in the oral flora. In this sub-analysis, we investigated how use of PVP-I or CPC products in the perioperative period affects postoperative changes in C-reactive protein (CRP). Methods Subjects who received PVP-I (n = 38) and CPC (n = 40) were divided based on a CRP threshold of 5 mg/dL. Tongue bacteria counts, operational taxonomic unit (OTU) counts, and Shannon Index immediately before surgery were compared in the high CRP (≥ 5 mg/dL) and low CRP (< 5 mg/dL) by Mann-Whitney U test. Dependent variables were selected from univariate results and stepwise multivariate logistic regression analysis was performed. Results There were significantly more patients with high CRP in the PVP-I group than in the CPC group. High CRP cases in the CPC group had significantly higher OTU counts and Shannon Index compared to low CRP cases in this group. Stepwise multivariate logistic regression analysis showed significant effects of the product (odds ratio 0.34) and Shannon Index (odds ratio 3.18). Conclusion Results of this study suggested that the use of CPC in POM was associated with lower CRP level. CRP is known to increase during postoperative period because of tissue inflammation. Shannon Index for tongue coating measured immediately before surgery is significantly lower in CPC group and may causes decreased CRP level. Trial registration number : UMIN000030919 (Date of registration: January 21, 2018)