Preoperative oral practices and incidence of postoperative complications in hospital medical-surgical procedures: A meta-analysis

Background: Oral decay prior to a hospital medical-surgical procedure is a risk factor for the development of postoperative complications. However, perioperative oral practices as a protective factor have not been studied. This review aims to evaluate the effectiveness of perioperative oral practices in the reduction of risk of developing postoperative complications in in-hospital medical surgical procedures. Material and methods: This review and meta-analysis was conducted according to Cochrane guidelines. Medline, Scopus, Scielo, and Cochrane were consulted. Articles of the previous 10 years concerning adult patients undergoing perioperative oral practices prior to hospital medical-surgical procedures, were included. Data of the type of perioperative oral practice, type of postoperative complication and measures of effect on the development of complications were extracted. Results: Of a pool of 1470 articles, 13 were included for systematic review and 10 for meta-analysis. The most common perioperative oral procedures were focalized approach (FA), referred to only the elimination of infectious foci in the oral cavity and comprehensive approach (CA), referred to a integral approach of the patient's oral health, both of which were mainly performed in oncologic surgeries, both were effective in the reduction of postoperative complications (RR=0.48, [95% CI 0.36 - 0.63]). The most reported postoperative complication was postoperative pneumonia. Conclusions: Perioperative oral management proved to be a protective factor against the development of postoperative complications. (AU)

Association between periodontitis and postoperative complications in hospital medical surgical procedures: a systematic review.

Background: Periodontitis is potentially harmful in the perioperative period due to biofilm generating a environment for bacteria to spread and colonize other anatomical areas, which can generate a potential risk of infection, delayed healing, increased morbidity, and even induce avulsion in intubated patients, and subsequent aspiration or ingestion of teeth with increased mobility. Objective: Associate the presence of periodontitis and postoperative complications in patients who underwent an in-hospital medical surgical procedure. Methods: A systematic review based on studies extracted from PubMed and Scopus was carried out on June 10, 2020, based on the Population, Intervention, Comparison and Result search strategy. As inclusion criteria, the studies had to include all the disaggregated terms of the research question, have a publication date of less than 15 years, and the target population had to have undergone elective hospital medical-surgical interventions. The exclusion criteria corresponded to not presenting an analytical or experimental observational study design, not having made a periodontal clinical diagnosis of the study subjects, and not expressing in the results the presence of postoperative medical-hospital complications. Articles were assessed for quality by supplementing the STROBE guideline and Newcastle Ottawa, for risk of bias by supplementing the STROBE guideline and the Cochrane Collaboration handbook tool. Results: A total of 131 articles were obtained, which were subjected to a selection process, resulting in 5 final analytical observational studies. A meta-analysis was performed and determined that periodontitis was a risk factor to postoperative complications after surgical procedures with an OR = 4,76; 95%CI [1,11-20,41]. Conclusions: Optimize the guidelines for assessing quality and risk of bias can make their comparison with other studies complex, however it was determined in a statistically significant way that patients with periodontitis have a higher risk of generating postoperative complications after a medical hospital surgery.

Introducción: La periodontitis es potencialmente dañina en el perioperatorio debido a que el biofilm genera un ambiente para que las bacterias se propaguen y colonicen otras áreas anatómicas, lo que puede generar un riesgo potencial de infección, retraso en la cicatrización, aumento de la morbilidad e incluso inducir avulsión en pacientes intubados, y aspiración o ingestión posterior de dientes con mayor movilidad. Objetivo: Asociar la presencia de periodontitis y complicaciones postoperatorias en pacientes sometidos a un procedimiento médico quirúrgico intrahospitalario. Métodos: Se realizó una revisión sistemática a partir de estudios extraídos de PubMed y Scopus el 10 de junio de 2020, basándose en la estrategia de búsqueda de Población, Intervención, Comparación y Resultados. Como criterios de inclusión, los estudios debían incluir todos los términos desagregados de la pregunta de investigación, tener una fecha de publicación menor a 15 años y la población objetivo debía haber sido sometida a intervenciones médico-quirúrgicas hospitalarias electivas. Los criterios de exclusión correspondieron a no presentar un diseño de estudio observacional analítico o experimental, no haber realizado un diagnóstico clínico periodontal de los sujetos de estudio y no expresar en los resultados la presencia de complicaciones médico-hospitalarias posoperatorias. Se evaluó la calidad de los artículos complementando la guía STROBE y Newcastle Ottawa, y el riesgo de sesgo complementando la guía STROBE y la herramienta del manual de Colaboración Cochrane. Resultados: Se obtuvo un total de 131 artículos, los cuales fueron sometidos a un proceso de selección, dando como resultado 5 estudios observacionales analíticos finales. Se realizó un metaanálisis y se determinó que la periodontitis fue un factor de riesgo de complicaciones posoperatorias después de procedimientos quirúrgicos con un OR = 4,76; IC95% [1,11-20,41]. Conclusiones: Optimizar las guías para evaluar la calidad y el riesgo de sesgo puede hacer compleja su comparación con otros estudios, sin embargo, se determinó de manera estadísticamente significativa que los pacientes con periodontitis tienen mayor riesgo de generar complicaciones posoperatorias luego de una cirugía médico hospitalaria.