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. 2024 Nov 8;9(11):1087-1096.
doi: 10.1530/EOR-24-0091.

Does intraoperative wound irrigation with diluted povidone-iodine prevent surgical site infection in spine surgery?

Xiaoping Mu  1   2 , Xiaodong Wei  1 , Zhuhai Li  1   2 , Minke Wei  1   2 , Jianxun Wei  1   2
Affiliations

Does intraoperative wound irrigation with diluted povidone-iodine prevent surgical site infection in spine surgery?

Xiaoping Mu et al. EFORT Open Rev. .

Abstract

Purpose: This study employed meta-analysis to evaluate whether the application of intraoperative wound irrigation (IOWI) with povidone-iodine (PI) in spine surgery effectively reduces the incidence of postoperative surgical site infection (SSI).

Methods: The present study was conducted strictly following the methodological guidance provided by the Cochrane Handbook. The protocol of this work was registered with PROSPERO. Two researchers independently conducted electronic searches in Medline via PubMed, Embase, Cochrane Library, and Web of Science. The bias risk of each included study was evaluated by two assessors. We performed statistical analysis on the dataset using STATA software.

Results: Fourteen studies involving a total of 6777 patients were included in the present work. The risk of bias of six included randomized controlled trials (RCTs) was considered as low-to-moderate risk, and the quality scores of the eight included retrospective cohort studies were rated as high quality. The results of this meta-analysis indicated a significant difference in the incidence of postoperative SSI between the two groups (RR = 0.29, 95% CI: (0.18, 0.47)). Moreover, patients who underwent IOWI with PI had lower rates of deep and superficial infections after spine surgery compared with the controlled group (superficial infection: RR = 0.28, 95%CI: (0.14, 0.54); Deep infection: RR = 0.24, 95%CI: (0.10, 0.60)). The sensitivity analysis results indicated good robustness and high evidence strength after data consolidation in the overall rate of postoperative SSI and the incidence of deep/superficial infection.

Conclusions: IOWI with PI solution during spinal surgery can effectively reduce the incidence of postoperative SSI.

Keywords: SSI; intraoperative wound irrigation; povidone-iodine; spine surgery; surgical site infection.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the study reported.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plot of the meta-analytic estimate for the overall rate of postoperative SSI.
Figure 3
Figure 3
Subgroup analysis of the meta-analytic estimate for the overall rate of postoperative SSI according to study design.
Figure 4
Figure 4
Forest plot of the meta-analytic estimate for the incidence of deep and superficial infection.
Figure 5
Figure 5
Sensitive analysis of the overall rate of postoperative SSI (5A), the incidence of deep infection (5B) or superficial infection (5C).
Figure 6
Figure 6
Funnel plot of the overall rate of postoperative SSI.
See this image and copyright information in PMC

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