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World Journal of Surgery
Published in: World Journal of Surgery 2/2019

01-02-2019 | Scientific Review

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

Authors: Manuel López-Cano, Miquel Kraft, Anna Curell, Mireia Puig-Asensio, José Balibrea, Manuel Armengol-Carrasco, Josep M. García-Alamino

Published in: World Journal of Surgery | Issue 2/2019

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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.
Appendix
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Metadata
Title
A Meta-analysis of Prophylaxis of Surgical Site Infections with Topical Application of Povidone Iodine Before Primary Closure
Authors
Manuel López-Cano
Miquel Kraft
Anna Curell
Mireia Puig-Asensio
José Balibrea
Manuel Armengol-Carrasco
Josep M. García-Alamino
Publication date
01-02-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 2/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4798-0

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