Recent Changes and Improvements in Multidisciplinary Perioperative Management From a Nutritional Perspective: Dental Specialty Should Be Considered Important

Abstract

Purpose of reviewRecently, multidisciplinary strategies on accelerated recovery postoperatively have been provided, and management of the perioperative period has changed and improved dramatically. We summarize the enhanced recovery after surgery (ERAS®) protocol and its outcomes from a nutritional perspective. We established the perioperative management center (PERiO), much of whose work contents conform to ERAS®, but intensive dental staff involvement is characteristic. We also summarize its outcomes. Recent findingsERAS® is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing a major surgery. Nutrition is a key pillar for patient-care. Throughout the perioperative period, oral nutrition is suggested as well as possible. Good outcomes have been reported by a meta-analysis of randomized controlled trials. However, dental staff are not regarded as part of the professional team.PERiO reported good outcomes of care bundles and suggested the importance of dental staff contribution. The Japanese social insurance system began to cover involvements of dental staff for perioperative oral management since 2012. Analysis of the nationwide administrative claims database in Japan concluded that preoperative oral care by a dentist significantly reduced postoperative complications in patients undergoing cancer surgery. SummaryCurrently, dental staff are not regarded as key professionals of ERAS®, although dental staff can contribute to good outcomes in the perioperative period and PERiO, and consequently the Japanese universal health insurance coverage system covering involvements of dental staff for perioperative oral management showed good outcomes. Therefore, further clinical studies involving the dental specialty should be considered important for perioperative management from nutritional perspectives.

Avaliação de saúde bucal e ocorrência de pneumonia durante internação hospitalar

“…Pacientes que não passaram por adequação do meio bucal prévio encontraram-se em unidades de terapia intensiva com várias alterações em cavidade oral 17,18 Nesse sentido, estudos que podem fornecer um alto nível de evidência, como ensaios clínicos controlados e randomizados, são difíceis de realizar porque a intervenção odontológica teria um benefício, e o controle negativo, que não teria nenhuma intervenção odontológica, não poderia ser estabelecido por uma questão ética. Apesar disso, existem alguns protocolos na literatura já validados e aplicados, como o ERAS e o PERIO que são desenvolvidos de forma multi e interdisciplinar 11,12 .…”

Sensitivity and specificity of the question “do you have any concerns regarding your mouth related to undergoing surgery?” for predicting perioperative oral health problems in patients with primary esophageal and lung cancer: a retrospective observational study

“…Along with the worldwide revolution in perioperative management, Okayama University Hospital established a perioperative management center (PERiO) in 2008 to maintain safe, authentic, and high-quality perioperative management (Yasuhara et al 2016 ; Soga et al 2019 ). PERiO is comprised of anesthesiologists, surgeons, dentists/dental hygienists/dental technicians, nurses, physical therapists, pharmacists, dieticians, and medical engineers (Yasuhara et al 2016 ; Soga et al 2019 ). Dental staff participate extensively in the multidisciplinary approach to perioperative management (Yasuhara et al 2016 ; Soga et al 2019 ).…”

“…PERiO is comprised of anesthesiologists, surgeons, dentists/dental hygienists/dental technicians, nurses, physical therapists, pharmacists, dieticians, and medical engineers (Yasuhara et al 2016 ; Soga et al 2019 ). Dental staff participate extensively in the multidisciplinary approach to perioperative management (Yasuhara et al 2016 ; Soga et al 2019 ). Dentists, dental hygienists, and dental technicians perform perioperative management aimed at preventing acute odontogenic pain caused by pulpitis and/or acute odontogenic infection during the perioperative period, enabling patients to achieve oral nutrition/ingestion by dental treatment, preventing dental injury during orotracheal intubation, preventing postoperative pneumonia by maintaining oral hygiene, and enabling safe oral nutrition by appropriate eating/swallowing functional evaluation and rehabilitation (Soga et al 2019 ).…”