REGISTRO DOI: 10.5281/zenodo.10574967
COSTA, Raquel Coelho Netto da1;
SOUSA, Franklin Monteiro de2;
FEITOSA, Telcilene Martins3;
FERREIRA, Meire Coelho4;
TAVAREZ, Rudys Rodolfo de Jesus5
ABSTRACT
The intensive involvement of the dentistry team as a multidisciplinary strategy in the preoperative period showed an accelerated recovery of patients undergoing oncological surgery. Protocols were adopted that included oral preparation before surgery, which brought good results in the postoperative period for these patients. However, perioperative oral practices as a protective factor have not yet been well understood and need to be further studied. OBJECTIVE: to present a medical-surgical care protocol for patients, with adaptation of the oral environment prior to major orthopedic surgeries, specifically hip arthroplasty, in a university hospital. SAMPLE: 23 patients who underwent an outpatient consultation with the orthopedic surgeon and were referred to the hospital’s dentistry service to adapt the oral environment prior to hip arthroplasty surgery. MATERIAL AND METHOD: Case series study in which the hospital records of 23 patients were evaluated to investigate the main postoperative complications found in a group where 100% of patients underwent previous mouth preparation. For this purpose, dental records were collected with patient data such as the patient’s medical record number, odontogram and report on the execution of the dental procedures performed. Two years after the adoption of this system, the patients’ medical records were coded and analyzed by a researcher who, using the hospital’s computer system, verified the length of stay for each patient, the execution of the procedure in the surgical center and the main reports of complications in each patient. patient such as postoperative infection, pneumonia, admission to an intensive care unit as well as the hospital discharge report. RESULTS: We observed that 100% of patients who underwent previous mouth preparation, none contracted pneumonia; There were no reports of dental loss or trauma during intubation or throughout the hospitalization period; The average length of stay was 9 days; There was one admission to the intensive care unit with a history of sepsis, cardiac arrest and subsequent death; Among the most reported postoperative complications, in addition to pain, we found volunteers with infection at the surgical site and two volunteers with deep vein thrombosis; 15 volunteers were discharged from hospital.
Keywords: perioperative manegement, dental, oral manegement.
INTRODUTION
The intensive involvement of the dentistry team as a multidisciplinary strategy in the preoperative period showed an accelerated recovery of patients undergoing oncological surgery. Protocols were adopted that included oral preparation before surgery, which brought good results in the postoperative period for these patients.1
Perioperative oral management is widely recognized in Japan’s healthcare system. Conventionally, the surgeon refers patients with oral problems to a dental or oral surgery clinic in the hospital. The effectiveness of introducing this system was demonstrated in 7715 patients undergoing oncological surgery. A 20% oral intervention rate significantly reduced the incidence of postoperative pneumonia and indicated that this system could be very useful in surgical patients.2,3
For positive neurosurgical results a multidisciplinary team consisting of anesthesiologists, dentists/hygienists/dental technicians, nurses, physiotherapists, pharmacists, and nutritionists was organized and this system decreased the duration of admission to surgery, and was found useful in providing discharge medical care.2
Oral diseases prior to a hospital medical-surgical procedure are a risk factor for the development of postoperative complications. However, perioperative oral practices as a protective factor have not yet been well understood and need to be further studied.4
OBJECTIVE
This work aims to show a medical-surgical care protocol for patients, with adaptation of the oral environment prior to major orthopedic surgeries, specifically hip arthroplasty, in a university hospital.
ETHICAL CONSIDERATIONS
Study was approved by the HUUFMA CEP under number 23178719.2.0000.5086. The volunteers signed the free and informed consent form.
SAMPLE
The sample consists of 23 patients who underwent an outpatient consultation with the orthopedic surgeon and were referred to the hospital’s dentistry service to adapt their oral environment prior to hip arthroplasty surgery. The oral adjustment carried out consisted of basically 4 steps: 5
- Supra-gingival and sub-gingival scaling improve gingivitis and periodontitis
- Extraction of condemned teeth
- Restoration of caries cavities with composite resin
- Guidance and oral hygiene and flossing
After the dental treatment, the patients were called for the elective medical-surgical procedure. Of these 23 patients, 7 were excluded for not having undergone the medical procedure, leaving 16 volunteers in the sample.
MATERIAL AND METHOD
Case series study in which the hospital records of 23 patients were evaluated to investigate the main postoperative complications found in a group where 100% of patients underwent previous mouth preparation. For this purpose, dental records were collected with patient data such as the patient’s medical record number, odontogram and report on the execution of the dental procedures performed.
Two years after the adoption of this system, the patients’ medical records were coded and analyzed by a researcher who, using the hospital’s computer system, verified the length of stay for each patient, the execution of the procedure in the surgical center and the main reports of complications in each patient. patient such as postoperative infection, pneumonia, admission to an intensive care unit as well as the hospital discharge report.
RESULTS
The results found were:
| PATIENT | DAYS | INFECTION | INTENSIVE CARE | DISCHARGE | PNEUMONIA | SEPSIS | CARDIAC ARREST | HAVEN’T HAD SURGERY YET | OTHERS |
| Case 1 | 2 | No | No | Yes | No | no | No | ||
| Case 2 | 2 | No | No | Yes | No | no | No | ||
| Case 3 | yes | ||||||||
| Case 4 | 3 | No | no | Yes | No | no | No | ||
| Case 5 | Yes | ||||||||
| Case 6 | 24 | yes | no | Yes | No | no | No | ||
| Case 7 | Yes | ||||||||
| Case 8 | 40 | yes | no | Yes | No | no | No | ||
| Case 9 | 9 | No | no | Yes | No | no | No | ||
| Case 10 | 3 | No | no | Yes | No | no | No | ||
| Case 11 | 2 | No | no | Yes | No | no | No | ||
| Case 12 | Yes | ||||||||
| Case 13 | 3 | No | no | Yes | No | no | No | ||
| Case 14 | 3 | No | no | Yes | No | no | No | ||
| Case 15 | 10 | No | no | Yes | No | no | No | Hiv, deep vein thrombosis | |
| Case 16 | 3 | No | no | Yes | No | no | No | ||
| Case 17 | Yes | ||||||||
| Case 18 | Yes | ||||||||
| Case 19 | 23 | No | no | Yes | No | no | No | deep vein thrombosis | |
| Case 20 | 4 | No | no | Yes | No | no | No | ||
| Case 21 | 10 | No | Yes | No | No | Yes | Yes | death | |
| Case 22 | Yes | ||||||||
| Case 23 | 3 | No | no | Yes | No | No | No |
We observed in the table above that of the 100% of patients who underwent previous mouth preparation, none contracted pneumonia;
There were no reports of tooth loss during intubation, extubation or throughout the hospitalization period;
The average length of stay was nine days;
There was one admission to the intensive care unit with a history of sepsis, cardiac arrest and subsequent death;
Among the most reported postoperative complications, in addition to pain, we found volunteers with infection at the surgical site and two volunteers with deep vein thrombosis;
Fifteen volunteers were discharged from hospital;
DISCUSSION:
Some protocols have been reported in the literature such as ERAS in which protocol items are developed and executed by a team of professionals, including surgeons, anesthetists, nurses, nutritionists, physiotherapists and others, and together they maintain control over the entire patient journey. patient and continually audit treatment. 1.2
Studies that can provide a high level of evidence, such as randomized controlled clinical trials, are difficult to carry out because the dental intervention must have a benefit, and the negative control, which would have no dental intervention, could not be established from an ethical point of view. Therefore, well-designed multicenter studies to evaluate relationships between the degree of dental intervention and perioperative benefits and outcomes are essential.
Currently, the contribution to general health through the maintenance of oral health is a significant topic in dentistry, as an example we have the effects of periodontal treatment on the metabolic control of diabetes, which has been studied extensively. 6.7
We found that the barrier between the dental team and the medical team is beginning to disappear in the field of perioperative management, allowing for better medical treatment such as the PERIO protocol widely developed in Japan. 1,2,3
CONCLUSION
More multicenter studies should be carried out with all types of patients from all surgical specialties to verify the real effectiveness of mouth preparation prior to major surgery.
REFERENCIAS
- Yoshihiko S Yasuhiro S Toshiyoshi F Takako A Hiroshi M. Recent Changes and Improvements in Multidisciplinary Perioperative Management From a Nutritional Perspective: Dental Specialty Should Be Considered Important. Current Oral Health Reports (2019) 6:70–75
- Takao Y, Tomohito H, Takashi A, Azuhiko K, Tomotsugu I, Asahiro K, Iko S, Joji , Asafumi H, Otomu K, Oshikazu M, Toshihiro S, Oshihiko S, Eiko Y, Takako A, Kemi A, Asuko H, Yasa M. Perioperative Management Center (PERIO) for Neurosurgical Patients Neurol Med Chir (Tokyo) 56, 574-579, 2016
- Hideki S , Yasuhiro K , Kosuke K , Ken-ichiro T , Yutaka M , Yukihiro M, Yoshimasa T and Ryoichi O Preventive Effects of Sustainable and Developmental Perioperative Oral Management Using the “Oral Triage” System on Postoperative Pneumonia after Cancer Surgery Int. J. Environ. Res. Public Health 2021, 18, 6296.
- Camus-Jansson F, Longueira-Diaz N, Salinas-Diaz B, Granic-Chinchón A, Cueto-Urbina W, Parra-Parra M , Lopez-de-Blanc S. Preoperative oral practices and incidence of postoperative complications in hospital medical-surgical procedures: A meta-analysis Med Oral Patol Oral Cir Bucal. 2023 May 1;28 (3):e217-28
- da Costa, R,, Cortez, G., Feitosa, M., Casanovas, R., Gomes. L, Campos, R., Garcia, E. (2022). Oral Health Assessment in Patients who will be Submitted Hip Arthroplasty. Mathews J Dentistry 6(1):29.
- Nunes-dos-santos, D ; Gomes, S; Rodrigues, V ; Pereira, A . Periodontal status and clinical outcomes in kidney transplant recipients: a systematic review. oral diseases , v. x, p. 1-13, 2019.
- Gomes, S. ; Rodrigues, V ; Nunes-dos-santos, D. ;Pereira, ALA. ; Peres, MA. . The relationship between periodontal status and hyperglycemia after kidney transplantation. clinical oral Investigations , v. 26, p. 397-406, 2022.
The authors would like to thank the volunteers who participated in the research as well as the UFMA University Hospital (EBSERH), PROSUP-CAPES and UNICEUMA.
1Doutorado em andamento UNICEUMA. raquelcoelhon@hotmail.com;
2Residente em Odontologia clínica médica e cirúrgica HUUFMA, franklinmonteiro97@gmail.com;
3Residente em Odontologia clínica médica e cirúrgica HUUFMA, Tel.feitosa10@gmail.com;
4Doutora em Odontotologia, professora do UNICEUMA, meire@uniceuma.br;
5Doutor em Odontologia, professor UNICEUMA, rudys.tavarez@ceuma.br