Sepsis caused by endotoxemia after surgical invasion is acknowledged to be highly problematic. The relation between endotoxemia during oral and maxillofacial surgery and the clinical symptoms of patients remains poorly understood. In this study, we measured endotoxin activity （EA） levels by EA assay in patients who had undergone surgery and evaluated the relation between the EA levels and grade of surgical invasiveness in patients undergoing oral and maxillofacial surgery. In addition, we investigated other laboratory data relevant to EA levels.
The study group comprised 14 patients who received moderately to severely invasive surgery at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital from April 2008 through December 2010. The patients were 4 men and 10 women aged 21 to 88 years （average 64 years） and were divided into two categories based on Kimura’s classification, severely invasive surgery （10 patients） and moderately invasive surgery （4 patients）. We measured EA levels at least three times, i.e., before, during, and after surgery and analyzed the relations of EA levels to the grade of surgical invasiveness, WBC （/μl）, CRP (mg/dl）, LDH （U/l）, and PNI.
The EA level during surgery was 0.25 ± 0.20 in the severely invasive surgery group and 0.17 ± 0.08 in the moderately invasive surgery group. Increases in EA levels were detected in 3 patients （0.4-0.59） in the severely invasive surgery group, 2 of whom developed postoperative infections at the surgical site. There was no correlation between EA levels of patients undergoing severely invasive surgery and those undergoing moderately invasive surgery. There was also no correlation of EA levels with surgical duration, bleeding volume, CRP level, or preoperative PNI level, although there was a tendency for EA levels to increase as the preoperative PNI level decreased.
In this study, there was no correlation between EA levels and the grade of surgical invasiveness in the oral and maxillofacial region, indicating that these surgical procedures do not provoke the proliferation of gram-negative bacteria or cause bacteremia. We could not demonstrate the usefulness of EA levels as a marker of inflammation. However, some patients who were malnourished preoperatively showed moderate elevations of EA levels during surgery. Therefore, our findings suggest that perioperative nutritional monitoring is important for preventing postoperative infection.
