The effect of preoperative skin preparation on clinical outcomes with incisional surgery: a network meta‐analysis. Issue 11 (14th June 2022)

• Record Type: Journal Article
• Authors: Hampton, Jacob; Park, Sean S. W.; Palazzi, Kerrin; Oldmeadow, Christopher; Carroll, Rosemary; Attia, John; Smith, Stephen R.
• Is Part Of: ANZ journal of surgery. Volume 92:Issue 11(2022)
• Page Start: 2859
• Page End: 2867
• Publication Date: 2022-06-14
• Subjects: skin antisepsis -- skin preparation -- surgical site infection; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.17831
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Preoperative skin antiseptics are used prior to surgery to reduce the risk of surgical site infection (SSI). There is debate as to which is the most effective. The aim of this network meta‐analysis (NMA) is to compare the effectiveness of different skin preparations at reducing SSIs in patients undergoing incisional surgery. Methods: The study protocol was published in PROSPERO (CRD4202181599) a priori with predefined search terms and inclusion/exclusion criteria. The skin preparations for comparison were: chlorhexidine/alcohol (CHA), chlorhexidine/water (CHW), poviodine/alcohol (PVIA), poviodine/water (PVIW). The records identified were screened by two authors independently by title, abstract and in full text. The revised tool for risk‐of bias (ROB2) assessment was used. Results: Twenty‐nine RCTs involving 15 796 patients were included in the NMA. A significant but small increase in the odds of infection was seen in the PVIW group compared to the CHA group (OR 1.34, 95%CrI 1.09–1.64), but other comparisons were not statistically significantly different. Ranking the treatment arms showed there was a 64% probability that CHA is the most effective and a 62.7% probability that PVIW is the least effective treatment. Conclusion: Chlorhexidine/alcohol (CHA) was found to be the most effective for prevention of superficial and deep SSI while PVIW was the least. There was no differences seen between CHA and PVIA, or CHW and PVIW. The superiority of CHA is likely due to the effect of the alcohol in the base. Hence the choice between CHA and PVIA should be based on health and cost considerations. Abstract : This is a network meta‐analysis that compared the effectiveness of different skin preparations at reducing surgical site infections in patients undergoing incisional surgery. It involved 15796 patients over 29 randomized control trials. Chlorhexidine/alcohol was found to be the most effective antiseptic solution for prevention of superficial and deep surgical site infections following surgery, while povidone/water was found to be the least effective.