Outcomes following thoracic surgery: the role of preoperative chlorhexidine mouthwash in the prevention of post-operative pneumonia

Background:The oropharynx is a reservoir for a multitude of commensal microorganisms. Natural defences exist to prevent the overgrowth, invasion and the transmission of these pathogens thereby reducing the incidence of respiratory, gastrointestinal and systemic infections. These defences are however breached by the invasive anaesthetic and surgical procedures associated with the thoracic surgery. Decontamination of the oral cavity prior to surgical intervention may potentially reduce the detrimental effects of such breaches. We evaluated the use of the preoperative chlorhexidine antiseptic mouthwash on the incidence of postoperative pneumonia.Methods: Data was collected from a prospective database for the study period (no chlorhexidine group A: 15/09/2008 -15/10/2008, n=195) and for study period (chlorhexidine group B: 16/10/2008-15/11/2008, n=190). Following the surgery, patients were investigated for the development of pneumonia based on the Guidelines for the Management of Hospital Acquired Pneumonia.Results:The incidence of the postoperative pneumonia was significantly reduced in the patients treated with preoperative chlorhexidine mouthwash (group A 10.52% v group B 2.56% p=0.003). The length of hospital stay was also found to be significantly shorter in the chlorhexidine group.Conclusions:The use of preoperative chlorhexidine mouthwash prior to the thoracic surgery results in a reduction in the development of the postoperative pneumonia.