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. 2023 Nov;27(11):6461-6470.
doi: 10.1007/s00784-023-05251-4. Epub 2023 Sep 20.

Impact of oral/dental disease burden on postoperative infective complications: a prospective cohort study

Hanako Suenaga  1   2 , Mark Schifter  3   4 , Nancy Chen  4 , Farheen Ali  5 , Karen Byth  6 , Chris Peck  3
Affiliations

Impact of oral/dental disease burden on postoperative infective complications: a prospective cohort study

Hanako Suenaga et al. Clin Oral Investig. 2023 Nov.

Abstract

Objectives: This prospective cohort study aimed to assess the association between dental disease burden and postoperative infective complications (POICs) in patients undergoing major surgical procedures under general anaesthesia.

Methods: Pre-surgical dental assessment was undertaken on patients planned for major surgery. Demographic and surgical variables including putative risk factors for POICs and POIC status were documented. The univariable association between POIC status and each factor was examined. Those variables associated at P value ≤ 0.2 were candidates for inclusion in multiple logistic regression models. Backward stepwise variable selection was used to identify the independent predictors for POIC in the best fitting logistic regression model. The area under the receiver operating curve (AUC) was used to quantify the model's global classification performance.

Results: Among the 285 patients, 49 patients (17.2%) had POICs. The independent predictors for POIC were expected length of hospital stay (4-6 days; odds ratio [OR] = 4.80, 95% confidence internal [CI]: 1.30-17.70, P = 0.018, 7-9 days; OR = 5.42, 95% CI: 1.51-19.41, P = 0.009, ≥ 10 days; OR = 28.80, 95% CI: 4.12-201.18, P < 0.001), four or more decayed teeth (OR = 6.03, 95% CI: 2.28-15.94, P < 0.001) and visible tongue plaque (OR = 3.21, 95% CI: 1.54-6.70, P = 0.002). The AUC was 0.78 (95% CI: 0.71-0.85) indicating good discrimination. A simple screening tool for POIC was developed.

Conclusions/clinical relevance: In addition to systemic/surgical factors, this study identified clinically detected decayed teeth and visible tongue plaque as independent predictors for POICs. Preoperative dental assessment/care might be beneficial to assess risk for POICs and improve postoperative outcomes.

Keywords: Oral bacteria; Postoperative infective complications; Preoperative dental care.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Subject selection decision tree. ASA, the American Society of Anesthesiologists physical status classification
Fig. 2
Fig. 2
Boxplots of the predicted probability of postoperative infective complication
Fig. 3
Fig. 3
The receiver operated curve (ROC) for the best fitting multiple logistic regression model and the scoring model showing the area under the curve (AUC): 0.78 (95% CI = 0.71–0.85) and 0.77 (95% CI = 0.69–0.84)
See this image and copyright information in PMC

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