Philippine Journal of Surgical Specialties Vol. 76, No. 1, January-June 2021, pp 25-74

Oral Hygiene for Improving Surgical Outcomes: A Systematic Review and Meta-analysis

Author(s): Marie Carmela Lapitan, MD, Joshua Vincent Baroña, MD, Giselle Celine Cerrillo-Villanueva, MD, and Brian Buckley, PhD


Introduction: Nosocomial infections such as surgical site infections (SSI) and postoperative pneumonia significantly contribute to a patient’s morbidity and mortality. This systematic review and meta-analysis evaluate the effectiveness of oral hygiene programs in reducing the incidence of nosocomial infections and related postoperative complications among all surgical patients.

Methods: The systematic review and meta-analysis were conducted in line with the Cochrane Handbook for Systematic Reviews of Interventions. Medline and the Cochrane controlled trials (CENTRAL) databases were searched. Two review authors independently selected the trials and extracted the outcome data. The risk of bias of each included study was assessed independently by two review authors using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was performed when more than one trial reported the same outcome for the same comparison.

Results: 29 systematic reviews and 59 randomized controlled trials were included in the review. Thirty-two trials compared chlorhexidine with placebo, 7 trials povidone iodine with placebo, 7 trials topical antibiotics with placebo, 1 trial essential oils with placebo, 3 trials other agents with placebo, and 5 trials toothbrushing with no toothbrushing. Five trials compared one agent with another agent, and 1 trial compared dosings and frequencies of chlorhexidine use. Chlorhexidine was associated with a reduced risk of nosocomial infection, nosocomial pneumonia, ventilator-associated pneumonia (VAP), and shorter hosptial stay, and no significant impact on surgical site infection rates, ventilator days and mortality. Povidone iodine did not show any significant benefit on reducing VAP rates, ventilator days, ICU days, or mortality when compared against placebo. Hexetidine,when compared with placebo showed similar incidences of VAP. Topical oral antibiotics did not provide significant reduction on VAP rates, ventilator days, ICU days and mortality rates, compared with placebo.

Conclusion: Oral hygiene offers benefits in terms of lower rates of nosocomial infection, nosocomial pneumonia, ventilator-associated pneumonia, surgical site infection, shorter ICU stay, less ventilator days and lower oral colonization / colony counts.

Key words: Oral Hygene