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A Meta-analysis of Prophylaxis of Surgical Site Infections with Topical Application of Povidone Iodine Before Primary Closure

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Abstract

Background

Povidone iodine (PVI) is a widely used antiseptic solution among surgeons. A meta-analysis based on randomized controlled trials (RCTs) was conducted to establish whether application of PVI before wound closure could reduce surgical site infection (SSI) rates.

Methods

Systematic review of MEDLINE/PubMed, Scopus, CINAHL, and Web of Science databases from inception to September 2017, with no language restrictions. Only RCTs were retrieved. The primary outcome was the SSI rate. Meta-analysis was complemented with trial sequential analysis (TSA).

Results

A total of 7601 patients collected from 16 RCTs were analyzed. A reduction in overall SSI rate was found (RR 0.64, 95% CI 0.48–0.85, P = 0.002, I2 = 65%), which was attributed to patients undergoing elective operations (n = 2358) and mixed elective/urgent operations (n = 2019). When RCTs of uncertain quality (n = 9) were excluded, the use of PVI before wound closure (n = 4322 patients) was not associated with a significant reduction of SSI (RR 0.81, 95% CI 0.55–1.20, P = 0.29, I2 = 51%) and was only significant in clean wounds (RR 0.25, 95% CI 0.09–0.70, P = 0.008, I2 = 0%). For the primary outcome, the TSA calculation using a relative risk reduction of 19% and an 11% proportion of control event rate (CER) with 51% of I2, the accrued information size (n = 4322) was 32.8% of the estimated optimal information size (n = 13,148).

Conclusions

There is no conclusive evidence for a strong recommendation of topical PVI before wound closure to prevent SSI.

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Acknowledgements

The authors are grateful to Marta Pulido, MD, PhD, for provision of editing services.

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Author notes

  1. Manuel López-Cano and Miquel Kraft have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Abdominal Wall Surgery Unit and General and Digestive Surgery Research Group, Institut de Recerca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autónoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Manuel López-Cano, Miquel Kraft, Anna Curell, José Balibrea & Manuel Armengol-Carrasco

  2. Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain

    Mireia Puig-Asensio

  3. Evidence-Based Healthcare, University of Oxford, Oxford, UK

    Josep M. García-Alamino

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  1. Manuel López-Cano
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Correspondence to Manuel López-Cano.

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López-Cano, M., Kraft, M., Curell, A. et al. A Meta-analysis of Prophylaxis of Surgical Site Infections with Topical Application of Povidone Iodine Before Primary Closure. World J Surg 43, 374–384 (2019). https://doi.org/10.1007/s00268-018-4798-0

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