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

• Published in: World journal of surgery 2019-02, Vol.43 (2), p.374-384
• Main Authors: López-Cano, Manuel, Kraft, Miquel, Curell, Anna, Puig-Asensio, Mireia, Balibrea, José, Armengol-Carrasco, Manuel, García-Alamino, Josep M.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cardiac Surgery; Clinical trials; General Surgery; Infections; Infectious diseases; Iodine; Medical personnel; Medicine; Medicine & Public Health; Meta-analysis; Patients; Povidone; Prophylaxis; Reduction; Scientific Review; Sequential analysis; Surgery; Surgical site infections; Systematic review; Thoracic Surgery; Topical application; Vascular Surgery; Wounds
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4798-0

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, I 2  = 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, I 2  = 51%) and was only significant in clean wounds (RR 0.25, 95% CI 0.09–0.70, P  = 0.008, I 2  = 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 I 2 , 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.