Povidone-Iodine 3.35% Solution versus Normal Saline for Irrigation in Lumbar Fusion Surgery: A Retrospective Study

Abstract

Background Data: Povidone-iodine is very effective broad spectrum antiseptic solution against different types of pathogens including methicillin-resistant Staphylococcus aureus and some strains of Enterococcus faecium based on the antiseptic properties of iodine. Purpose: To evaluate the effect of intraoperative 3.35 % povidone-iodine irrigation in lumbar spine fusion surgeries. Study Design: Retrospective clinical case study. Patients and Methods: 93 spine fusion surgeries in 2016 (Group I) and 112 fusion surgeries in 2017 (Group II). Both groups were retrospectively compared regarding infection rate, fusion rate, and Oswestry Disability Index (ODI) score. Group I had intraoperative saline irrigation and Group II was irrigated with 3.35 % povidone-iodine. Results: There were no reported infections in Group II. Two superficial and two deep wound infections were observed in Group I. Complete wound dehiscence was found in one patient with deep wound infection. The pathogens were methicillin-resistant Staphylococcus aureus in two cases, Klebsiella pneumonia in one case, and combination of methicillin-sensitive Staphylococcus aureus and Staphylococcus epidermidis in the last case. There was insignificant difference between the two groups in fusion rates and with no linear correlation relationship between povidone-iodine soaking time and the fusion rate in Group II. There was significant postoperative ODI improvement in the two groups relative to the preoperative scores with insignificant statistical difference when comparing this improvement of the two groups. Conclusion: Povidone-iodine 3.35% irrigation in lumbar spine fusion surgery is effective in decreasing postoperative infection with no negative influence on the fusion rate or clinical outcome. (2019ESJ177)

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

“…Moreover, they did not find any linear correlation between PVI soaking time and the fusion rate. 13 We found almost similar results with higher doses of PVI; however, the infection rate did not decrease to zero in the current experiment. In addition to wound irrigation, several patients, wounds, and environmental strategies are needed to prevent intra-operative wound contamination, 5 which explains the dissimilarity of infection rates.…”

“…Recent clinical studies have shown that wound irrigation with PVI significantly reduces the infection rate in spinal surgeries without causing any serious side effects. 12,13,20,21 While there is no consensus on the safe dose and irrigation time with PVI. J Strohecker et al found that intra-lumbar disc surgery lavage of diluted PVI decreases the infection rate by 1.6%; however, the concentration of PVI was not provided.…”

A meta‐analysis examining the impact of intrawound treatment on reducing deep surgical site infections during instrumented spine surgery

“…2950 relevant papers were looked at, and 29 studies published between 2006 and 2023 met the criteria to be included in the meta‐analysis 13,14,24–50 …”

“…For the current meta‐analysis, 29 examinations from 2006 to 2023 were included; of these, 11 181 people had instrumented SS of them 4421 were using vancomycin as intrawound management, 908 were using povidone‐iodine, and 5852 were using control. The sample size was 41–1822 people 13,14,24–50 . The data that was looked at showed that using vancomycin and povidone‐iodine as intrawound management had a much lower deep SSI than using a control group of instrumented SS subjects.…”

The Anesthetist

“…There is limited data on the safety dose spectrum of PVI for spinal surgeries. [12][13][14] On the other hand, normal saline has the lowest toxicity, but it only dilutes and does not cleanse the contaminants. 13 We conducted the current randomized clinical trial aimed to evaluate the effect of wound irrigation with PVI and normal saline on infection rate, wound healing, fusion status and clinical outcomes of spinal surgery.…”