Preoperative dental screening prior to cardiac valve surgery and 90-day postoperative mortality.

BACKGROUND: Preoperative dental screening before cardiac valve surgery is widely accepted but its required scope remains unclear. This study evaluates two preoperative dental screening (PDS) approaches, a focused approach (FocA) and a comprehensive approach (CompA), to compare postsurgical 90-day mortality. METHODS: Retrospective cohort analysis was performed on all patients who underwent valve surgery at Brigham and Women's Hospital with FocA and Massachusetts General Hospital with CompA of PDS approach from January 2009 to December 2016. Patients with intravenous drug abuse and systemic infections were excluded. Univariate, multivariable, and subgroup analysis was performed. RESULTS: A total of 1835 patients were included in the study. With FocA 96% of patients (1097/1143) received dental clearance in a single encounter with 3.3% receiving radiographs and undergoing dental extractions. With CompA 35.5% of patients (245/692) received dental clearance in a single encounter, 94.2% received radiographs, and 21.8% underwent dental extractions. There was no significant difference in 90-day mortality when comparing both PDS approach (10% vs 8.4%, P = .257). This remained unchanged in a multivariable model after adjusting for risk factors (odds ratio:1.32 [95%CI:0.91-1.93] [P = .14]). Reoperation due to infection was less in FocA (0.5%) vs CompA (2.6) (P < .001) and postoperative septicemia was increased in the FocA (1.7%) cohort when compared to the CompA (0.7%) (P < .001) patients. CONCLUSIONS: There was no difference in post valve surgery 90-day mortality between patients who underwent a FocA vs CompA of PDS.

An analysis of patient grievances in a dental school clinical environment.

Patient satisfaction is an integral part of assessing the quality of oral health care. As dental care becomes more impersonal, competitive, and expensive, the potential for patient complaints is on the rise. Dental school clinics may be more vulnerable to patient grievances due to inexperienced student providers, less efficient delivery of care, challenges related to continuity of care, and the complexity of adhering to institutional policies. Effective management of patient complaints can assist both individuals and institutions toward providing the highest quality of care achievable in the demanding dental education environment. Despite the obvious benefit, there is a dearth of recent studies that analyzed complaints in either the private practice setting or dental school clinics. The purpose of this study was to categorize and analyze the complaints received from patients seeking treatment at a large dental school clinic from 2005 to 2008. It was found that the combined complaints for all four years in descending order were regarding appointment, communication, money, quality, and other. No statistically significant association was found between the type of complaint and time of year. Most importantly, it was found that the system for recording complaints needed to be standardized in order to improve the quality of patient care. The findings from this study will not only facilitate adjustment of the school's current curricula and policies, but could also guide other institutions and private dental practitioners toward better patient care.