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. 2011 Jun;4(3):97-106.
doi: 10.4021/gr319e. Epub 2011 May 20.

Povidone-Iodine Irrigation of Subcutaneous Tissues May Decrease Surgical Site Infections in Elective Colorectal Operations: A Systematic Review

Richdeep S Gill  1 , David P Al-Adra  1 , Sandy Campbell  2 , David W Olson  1 , Brian H Rowe  3
Affiliations

Povidone-Iodine Irrigation of Subcutaneous Tissues May Decrease Surgical Site Infections in Elective Colorectal Operations: A Systematic Review

Richdeep S Gill et al. Gastroenterology Res. 2011 Jun.

Abstract

Background: Postoperative wound infection is the most common complication following abdominal surgery and leads to delayed wound healing, prolonged hospital length of stay (LOS), and causes morbidity. Povidone-Iodine (PVI) is a broad-spectrum anti-septic and disinfectant solution, and can be used intra-operatively to irrigate subcutaneous tissues prior to abdominal skin closure. We systematically reviewed the literature regarding the efficacy of intra-operative PVI irrigation of subcutaneous tissues following elective colorectal surgery.

Methods: A comprehensive search of electronic databases and various grey literature sources was completed. Unpublished and non-English-language results were included. All clinical controlled trials involving PVI solution in adult colorectal surgery were included. Two independent reviewers assessed the studies for relevance, inclusion, methodological quality and extracted data from the full versions of the manuscripts. Disagreements were resolved by re-extraction or third party adjudication. Data for dichotomous outcomes are reported as relative risks (RR) with 95% confidence intervals (CI). For continuous data, mean differences (MD) are reported with 95% CIs.

Results: Five randomized controlled trials (RCTs) involving 205 patients comparing PVI solution or spray to a control group following abdominal fascial closure in elective colorectal or clean-contaminated operations were identified. Pooled results demonstrated a reduction in surgical site infection for patients treated with PVI (RR = 1.97; 95% CI: 1.22 to 3.17) compared to controls.

Conclusions: Irrigation of subcutaneous tissues with PVI following abdominal fascial closure is associated with a reduced incidence of surgical site infection. Due to the small number of included trials and patients, additional robust randomized trials are needed.

Keywords: Colorectal operation; Povidone-Iodine; Surgical site infection.

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Figures

Figure 1
Figure 1
Systematic review PRISMA flow diagram.
Figure 2
Figure 2
Forest plot of odds ratio for Povidone-Iodine treatment compared to controls.
Figure 3
Figure 3
Forest plot of risk ratio for Povidone-Iodine treatment compared to controls.
Figure 4
Figure 4
Methodological quality of included studies graph. Methodological quality graph: review authors’ judgments about each methodological quality item presented as percentages across all included studies.
Figure 5
Figure 5
Methodological quality summary of included studies. Methodological quality summary: review authors’ judgments about each methodological quality item for each included study.
Figure 6
Figure 6
Sensitivity analysis based on high methodological quality.
Figure 7
Figure 7
Sensitivity analysis based on low methodological quality.
See this image and copyright information in PMC

References

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