Preventive Effects of Sustainable and Developmental Perioperative Oral Management Using the “Oral Triage” System on Postoperative Pneumonia after Cancer Surgery

Abstract

Perioperative oral management is widely recognized in the healthcare system of Japan. Conventionally, the surgeon refers patients with oral problems to a dental or oral surgery clinic in the hospital. However, frequent in-house referrals were found to increase the number of incoming patients resulting in unsustainable situations due to an insufficient workforce. In 2011, the Center for Perioperative Medicine was established at our hospital to function as a management gateway for patients scheduled to undergo surgery under general anesthesia. The “oral triage” system, wherein a dental hygienist conducts an oral screening to select patients who need preoperative oral hygiene and functional management, was established in 2012. A total of 37,557 patients who underwent surgery at our hospital from April 2010 to March 2019 (two years before and seven years after introducing the system) were evaluated in this study. The sustainability and effectiveness of introducing the system were examined in 7715 cancer surgery patients. An oral management intervention rate of 20% and a significant decrease in the incidence of postoperative pneumonia (aOR = 0.50, p = 0.03) indicated that this system could be useful as a sustainable and developmental oral management strategy to manage surgical patients with minimal human resources.

Factors That Influence the Judgment of Oral Management Necessity in Preoperative Oral Screening

“…In addition, we found that the older patients needed more extensive oral management. These results are supported by past reports that older people have more oral troubles [14] and are at a greater risk of the onset of postoperative pneumonia [11].…”

“…There have been only a few studies on preoperative oral screening. For instance, Sekiya et al [11] evaluated nine categories (i.e., teeth movement, gingiva inflammation, dental calculus, dental plaque, tongue, xerostomia, halitosis, dysphagia, and trismus) and recommended patients to visit an oral surgery clinic if there was even one problematic finding. As a result, the number of patients who underwent oral screening and required oral management was found to range from 16.4% to 26.5%.…”

“…We only asked whether patients had family dentistry; we should have instead asked whether they undergo oral care maintenance regularly, or when did they last visit their dentist. Cooperation with a family dentist is important, and we have to provide them with information about the patients' condition or necessary dental treatment [10,11,21]. Particularly, the manpower of dentists may be insufficient in private hospitals, requiring medical cooperation.…”

“…The number of surgeries has increased with aging and the application of minimally invasive surgical methods, which has made it difficult to evaluate the oral status of all patients undergoing surgery. In addition, if all patients who do not require dental treatment visit dentists, it may contribute to the increase in medical costs and burden on patients [11]. Unfortunately, there are only a few studies that have focused on preoperative oral screening tools.…”

Cost-Effectiveness Analysis of Perioperative Oral Management after Cancer Surgery and an Examination of the Reduction in Medical Costs Thereafter: A Multicenter Study

“…In addition, the protocol for the technique of perioperative oral management has not been standardized at the eight institutions. However, according to Sekiya et al [ 10 ], this management method is positioned as a conventional system in the Japanese classification of perioperative oral management systems. In other words, this is a system in which professional oral management is performed only when the surgeon in charge requests oral management before the operation.…”