大腸癌手術後の手術部位感染予防に対する周術期経口管理の効果：傾向スコアを用いた共分散分析による698例の多施設レトロスペクティブ解析

Effect of perioperative oral management on the prevention of surgical site infection after colorectal cancer surgery: A multicenter retrospective analysis of 698 patients via analysis of covariance using propensity score.

抄録

手術部位感染（SSI）は、大腸癌手術後に頻発する術後合併症の1つである。口腔ケアは、口腔癌、食道癌、肺癌の手術におけるSSIや術後肺炎のリスクを減少させることが報告されている。本研究の目的は、大腸癌大手術後のSSI発症に対する周術期口腔管理の予防効果を検討することである。国内2病院で大腸癌手術を受けた698例のカルテをレビューした。これらの患者のうち、563例が周術期の経口管理を受け（経口管理群）、135例が受けなかった（対照群）。周術期の経口管理介入を含む人口統計学的変数、癌関連変数、および治療関連変数とSSIの発生を調査した。各変数とSSI発生との関係は、Fisher exact検定、一元配置分散分析（ANOVA）、ロジスティック回帰を用いた単変量解析および多変量解析により検討した。2群におけるSSIの発生は、傾向スコアを共変量として用いたロジスティック回帰により評価した。SSIは698例中68例（9.7％）に発生した。多変量解析の結果、手術時間、出血量、および周術期の経口管理がSSIの発生と有意な相関を示した。しかし、傾向スコア解析の結果、周術期の経口管理を受けなかったこともSSIの有意な危険因子となった。経口管理群のオッズ比は0.484（P = 0.014；95％信頼区間：0.272-0.862）であった。周術期の経口管理は、大腸癌手術後のSSIリスクを低下させ、術後在院日数を短縮する。

Surgical site infection (SSI) is 1 of the frequent postoperative complications after colorectal cancer surgery. Oral health care has been reported to reduce the risk of SSI or postoperative pneumonia in oral, esophageal, and lung cancer surgeries. The purpose of the study was to investigate the preventive effect of perioperative oral management on the development of SSI after a major colorectal cancer surgery.The medical records of 698 patients who underwent colorectal cancer surgery at 2 hospitals in Japan were reviewed. Among these patients, 563 patients received perioperative oral management (oral management group) and 135 did not (control group). Various demographic, cancer-related, and treatment-related variables including perioperative oral management intervention and the occurrence of SSI were investigated. The relationship between each variable and the occurrence of SSI was examined via univariate and multivariate analyses using Fisher exact test, 1-way analysis of variance (ANOVA), and logistic regression. The occurrence of SSI in the 2 groups was evaluated via logistic regression using propensity score as a covariate. The difference in mean postoperative hospital stay between the oral management and control groups was analyzed using Student's t test.SSI occurred in 68 (9.7%) of the 698 patients. Multivariate analysis showed that operation time, blood loss, and perioperative oral management were significantly correlated with the development of SSI. However, after the propensity score analysis, not receiving perioperative oral management also became a significant risk factor for SSI. The odds ratio of the oral management group was 0.484 (P = .014; 95% confidence interval: 0.272-0.862). Mean postoperative hospital stay was significantly shorter in the oral management group than in the control group.Perioperative oral management reduces the risk of SSI after colorectal cancer surgery and shortens postoperative hospital stay.