Effect of planned preoperative oral care implemented at least 2 weeks before surgery on postoperative infections: A single-center retrospective observational study

Abstract

This study aimed to investigate whether initiating oral care more than 2 weeks before surgery could prevent postoperative infections, particularly pneumonia. This retrospective observational study analyzed 1,806 patients who underwent surgery at the Ehime University Hospital between April 2019 and March 2023. The patients were divided into two groups: those receiving structured oral care at least 2 weeks before surgery (n = 257) and those receiving late or no oral care (n = 1,549). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to minimize selection bias. Nevertheless, residual confounding factors, especially confounding by indication, may remain, because as patients who received early oral care may differ systematically from those who did not. The primary outcome measure was the incidence of postoperative pneumonia. After PSM and IPTW analyses, the early oral care group showed significantly lower rates of postoperative pneumonia than the control group (risk difference: −3.56%, 95% confidence interval [CI]: −4.89% to −2.23%, p = 0.0004 in the matched analysis; −3.68%, 95% CI: −4.61% to −2.75%, p < 0.001 in the IPTW analysis). IPTW analysis demonstrated shorter hospital stays in the early oral care than in the control group (mean difference: −2.65 days, 95% CI: −4.75 to −0.55, p = 0.013). Implementing structured oral care at least 2 weeks before surgery reduced postoperative pneumonia and shortened hospital stays across various surgical procedures, suggesting its value as a preventive strategy for improving surgical outcomes.