Impact of perioperative oral care on postoperative infections in patients with head and neck cancer: A retrospective study comparing before and during the coronavirus disease 2019 pandemic

Azusa Kai; Kimie Fujita; Naohisa Wada; Takashi Nakagawa

doi:10.1016/j.anl.2025.10.003

Impact of perioperative oral care on postoperative infections in patients with head and neck cancer: A retrospective study comparing before and during the coronavirus disease 2019 pandemic

Auris Nasus Larynx. 2025 Dec;52(6):735-743. doi: 10.1016/j.anl.2025.10.003. Epub 2025 Oct 22.

Authors

Azusa Kai¹, Kimie Fujita², Naohisa Wada³, Takashi Nakagawa⁴

Affiliations

¹ Department of Health Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashi-ku Fukuoka City, Fukuoka 812-8582, Japan.
² Department of Health Sciences, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi Higashi-ku Fukuoka City, Fukuoka 812-8582, Japan. Electronic address: fujita.kimie.874@m.kyushu-u.ac.jp.
³ Department of General Dentistry, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi Higashi-ku Fukuoka City, Fukuoka 812-8582, Japan.
⁴ Department of Otolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku Fukuoka City, Fukuoka 812-8582, Japan.

PMID: 41130028
DOI: 10.1016/j.anl.2025.10.003

Abstract

Objective: Infection prevention is crucial in head and neck cancer surgery due to the high risk of surgical site contamination by oral bacteria and pharyngeal secretions. The coronavirus disease 2019 (COVID-19) pandemic has introduced significant challenges to infection control in medical settings, including restrictions on patient care and changes to perioperative management. This study investigated the incidence of postoperative pneumonia (PP) and surgical site infection (SSI) before and during the COVID-19 pandemic, and examined how perioperative oral care and oral hygiene status were associated with the occurrence of postoperative infections.

Methods: We retrospectively reviewed the medical records of patients who underwent head and neck cancer surgery between January 2018 and March 2022. The incidences of PP and SSI were compared before and during the COVID-19 pandemic. In addition, variables identified by univariate analysis as predictors of postoperative infection were incorporated and examined using logistic regression analysis.

Results: A total of 213 patients were included in this study. The incidence rates of PP and SSI were 15.0% and 24.4%, respectively, with no statistically significant difference before and during the pandemic. The risk factors for PP included preoperative oral dryness (odds ratio [OR] = 2.65; 95% confidence interval [CI] = 1.14-6.17; p = 0.024), and diabetes (OR = 2.65; 95% CI = 1.04-6.72; p = 0.040), while for SSI, the risk factors included lack of postoperative oral care (OR = 0.29; 95% CI = 0.10-0.86; p = 0.026), prolonged operative time (OR = 1.80; 95% CI = 1.09-2.99; p = 0.022), and preoperative radiotherapy (OR = 2.25; 95% CI = 1.02-4.95; p = 0.044).

Conclusion: Appropriate perioperative oral care remains essential, even in the post-COVID-19 era. This study highlights the importance of preventing oral dryness before surgery and ensuring continuous professional oral care before and after surgery to prevent postoperative infections.

Keywords: COVID-19; Head and neck cancer; Oral care; Postoperative pneumonia; Surgical site infection.

Publication types

Comparative Study

MeSH terms

Adult
Aged
COVID-19* / epidemiology
COVID-19* / prevention & control
Female
Head and Neck Neoplasms* / surgery
Humans
Incidence
Male
Middle Aged
Oral Hygiene*
Perioperative Care*
Pneumonia* / epidemiology
Postoperative Complications* / epidemiology
Postoperative Complications* / prevention & control
Retrospective Studies
Risk Factors
SARS-CoV-2
Surgical Wound Infection* / epidemiology
Surgical Wound Infection* / prevention & control