Operative site irrigation with povidone-iodine solution in spinal surgery for surgical site infection prevention: Can it be used safety?

Sigari, Reza Akhavan; Abdolhoseinpour, Hesam

doi:10.35975/apic.v24i3.1282

Cited by 2 publications

(9 citation statements)

References 18 publications

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“…Reasons for exclusion after full-text review are listed in eTable 1 in Supplement 1. We included 41 RCTs in our systematic review and 37 RCTs in the network meta-analysis, due to lack of events in all arms in 4 studies . The study characteristics of the RCTs included in the systematic review are listed in eTable 2 in Supplement 1.…”

Section: Resultsmentioning

confidence: 99%

“…All but 2 studies described the antibiotic solutions to be aqueous. All antiseptic solutions studied were aqueous, with 18 RCTs investigating iodine solutions ranging from 0.1% to 10% in concentration. Other antiseptics used were polyhexanide, chlorhexidine, hydrogen peroxide, and electrolyzed strongly acidic aqueous solution .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…We carried out a subgroup analysis on the 15 studies that investigated clean surgery (eFigure 1A in Supplement 1). Eleven of these 15 RCTs reported at least 1 SSI and were, therefore, included in the network meta-analysis. The only significant benefit was found for antiseptic solutions compared with saline solutions, as seen in the league table (RR, 0.21; 95% CI, 0.08-0.51).…”

Section: Resultsmentioning

confidence: 99%

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Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Groenen,

Bontekoning,

Jalalzadeh

et al. 2024

JAMA Surg

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ImportanceSurgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use.ObjectiveTo compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery.Data SourcesPubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023.Study SelectionIncluded in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded.Data Extraction and SynthesisThis systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported.Main Outcome and MeasureThe primary study outcome was SSI.ResultsA total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty).Conclusions and RelevanceThis systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Groenen,

Bontekoning,

Jalalzadeh

et al. 2024

JAMA Surg

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“…In 2020, Sigari et al reported on 936 spinal fusion surgery patients who were randomized to receive irrigation with either 3% PVP-I solution followed by normal saline for a maximum of two minutes (study group) or normal (control group). They did not find significant decreases in deep and superficial infections when analyzed individually, but did report the overall infection rate (deep + superficial) was reduced in the PVP-I group (4.8% to 1.1%, p = 0.032) [17].…”

Section: Povidone-iodinementioning

confidence: 91%

Irrigation techniques used in spine surgery for surgical site infection prophylaxis: a systematic review and meta-analysis

Torres

Konrade

White

et al. 2022

BMC Musculoskelet Disord

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Background The greater likelihood of morbidity, mortality, length of hospital stays and poorer long-term outcomes as a result of surgical site infections secondary to spinal surgery makes prophylactic measures an imperative focus. Therefore, the aim of this review was to evaluate the available research related to the efficacy of different intraoperative irrigation techniques used in spinal surgery for surgical site infection (SSI) prophylaxis. Methods We performed a comprehensive search using Ovid Medline, EMBASE, Web of Science and the Cochrane library pertaining to this topic. Our meta-analysis was conducted according to PRISMA guidelines. The inclusion criteria consist of spine surgeries with intraoperative use of any wound irrigation technique, comparison groups with a different intraoperative irrigation technique or no irrigation, SSI identified with bacterial cultures or clinically in the postoperative period, reported SSI rates. Data extracted from eligible studies included, but was not limited to, SSI rates, irrigation technique and control technique. Exclusion criteria consist of articles with no human subjects, reviews, meta-analyses and case control studies and no details about SSI identification or rates. Pooled risk ratios were calculated. A meta-analysis was performed with a forest plot to determine risk estimates’ heterogeneity with I2 index, Q-statistic, and p value under a random-effects model. Funnel plot was used to assess publication bias. All databases were last checked on January, 2022. PROBAST tool was used to assess both risk of bias and applicability concerns. Results After reviewing 1494 titles and abstracts, 18 articles met inclusion criteria. They included three prospective randomized-controlled trials, 13 retrospective cohort studies, two prospective cohort studies. There were 54 (1.8%) cases of SSIs in the povidone-iodine irrigation group (N = 2944) compared to 159 (4.6%) in the control group (N = 3408). Using intraoperative povidone-iodine wound irrigation produced an absolute risk reduction of 2.8%. Overall risk ratio was 0.32 (95% CI 0.20–0.53, p < 0.00001). In a global analysis, study heterogeneity and synthesizing mostly retrospective data were primary limitations. Conclusion The most evidence exists for povidone-iodine and has Level 2 evidence supporting SSI reduction during spinal surgery. Other antiseptic solutions such as dilute chlorhexidine lack published evidence in this patient population which limits the ability to draw conclusions related to its use in spinal surgery. Level of Evidence II – Systematic Review with Meta-Analysis.

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Operative site irrigation with povidone-iodine solution in spinal surgery for surgical site infection prevention: Can it be used safety?

Cited by 2 publications

References 18 publications

Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Irrigation techniques used in spine surgery for surgical site infection prophylaxis: a systematic review and meta-analysis

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