The association between perioperative oral care and adverse clinical events after complex cardiac surgery in children

Oral health is closely linked to various clinical complications, and maintaining good oral care has become one of the important interventions to reduce the risk of adverse clinical events. However, the association of oral health care with sepsis and cardiac function remains controversial. We investigated whether daily oral health care contributed to a reduced risk of sepsis and deteriorating cardiac function after complex cardiac surgery in children. We obtained data from 124 pediatric patients who were hospitalized in the ICU wards of our hospital after complex cardiac surgery between June 30, 2008 and December 31, 2022. Daily oral care was administered to these pediatric patients, and its association with sepsis risk and cardiac function was analyzed using multivariate logistic regression analysis. The incidence rates of our primary outcomes, including sepsis and deteriorated heart function, were 16 (12.9%) and 23 (18.5%), respectively. Multivariate logistic regression showed that the risk of sepsis (adjusted OR = 2.32, 95% CI: 1.36-4.32; P = 0.026) and deteriorated heart function (adjusted OR = 1.83, 95% CI: 1.09-3.14; P = 0.039) was significantly higher in pediatric patients without receiving oral health care than in those receiving oral care in Model 2, respectively. Sensitivity analysis still indicated that daily oral care contributed to a reduced risk of sepsis and deteriorating cardiac function in pediatric patients after cardiac surgery. Furthermore, the negative association of oral health with the adverse primary outcome was stronger among patients using 2% oral chlorhexidine rinse than among patients using 0.9% physiological saline. Daily oral care was associated with a lower risk of sepsis and deteriorating cardiac function in pediatric patients after complex cardiac surgery. This provides further evidence for the importance of oral health in reducing adverse clinical events, particularly in critically ill pediatric patients.