Perioperative Oral Management to Prevent Surgical Site Infection: A Meta-Analysis and Systematic Review

Yuwei Lin; Enhong Li; Yang Xiao; Feiruo Hong; Qiuyu Zhou; Xuefen Yu

doi:10.1111/ans.70376

Perioperative Oral Management to Prevent Surgical Site Infection: A Meta-Analysis and Systematic Review

ANZ J Surg. 2025 Dec;95(12):2448-2459. doi: 10.1111/ans.70376. Epub 2025 Nov 18.

Authors

Yuwei Lin^{1

2}, Enhong Li^{1

2}, Yang Xiao^{1

2}, Feiruo Hong^{1

2}, Qiuyu Zhou^{1

2}, Xuefen Yu²

Affiliations

¹ School of Medicine, Zhejiang University, Hangzhou, China.
² Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Zhejiang Key Laboratory of Oral Biomedical, Hangzhou, China.

PMID: 41251294
DOI: 10.1111/ans.70376

Abstract

Background: Surgical site infections represent one of the most common and costly hospital-acquired infections. As a potential preventive measure for surgical site infections, the specific effectiveness of perioperative oral management remains unclear.

Methods: We conducted systematic searches, study selection, data extraction, and meta-analysis. Subgroup analysis was performed based on patient disease type, surgical site, intervention type, and intervention frequency to assess the effects of perioperative oral management under different conditions. Additionally, the certainty of evidence for critical outcomes was evaluated through the GRADE framework.

Results: Sixteen studies were finally included, comprising 10 052 patients. Both experimental studies (RR = 0.64; 95% CI, 0.48-0.85; p = 0.002) and observational studies (OR = 0.49; 95% CI, 0.37-0.65; p < 0.001) indicate that perioperative oral management significantly reduced the risk of surgical site infections. Subgroup analyses revealed a more modest effect of perioperative oral management (POM) in patients with cardiovascular disease (OR = 0.72; 95% CI, 0.54-0.96; p = 0.027) and non-oncology patients (OR = 0.66; 95% CI, 0.48-0.92; p = 0.013). It is crucial to note that POM protocols excluding both oral chemical and mechanical cleaning components showed no significant effect (OR = 0.76; 95% CI, 0.44-1.31; p = 0.323). Additionally, perioperative oral management was associated with a reduction in hospital length of stay (MD = -1.88; 95% CI, -2.98 to -0.78; p = 0.001).

Conclusion: Perioperative oral management significantly reduces surgical site infections and shortens hospital stays. In clinical practice, patient-specific oral management plans should be developed to enhance perioperative infection control. Future studies are needed to explore the best practices and scope of application of preoperative oral management.

Keywords: general surgery; perioperative care; perioperative oral management; surgical site infections; systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Humans
Oral Hygiene* / methods
Perioperative Care* / methods
Surgical Wound Infection* / prevention & control