Prevention of Surgical Site Infection Following Open Spine Surgery: The Efficacy of Intraoperative Wound Irrigation with Normal Saline Containing Gentamicin Versus Dilute Povidone-Iodine.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2023;11(14):12 World Neurosurg. 2023 May;173: e1-e10.What this means for my practice?
A diluted povidone-iodine solution used in intra-operative wound irrigation provided significantly better surgical site infection prophylaxis compared to a gentamicin solution for patients undergoing open spine surgery. The results of this study are particularly relevant to non-Western countries, as this study was conducted in Nigeria. This study was limited by the exclusion of most risk factors for surgical site infection in the exclusion criteria and potential misdiagnosis of some patients given the difficulty of assessing early surgical site infection in some populations.
Study Summary
80 patients undergoing open spine surgery were randomized to receive intra-operative wound irrigation with a gentamicin/saline solution (n=40) or a diluted povidone-iodine solution (n=40). The outcome of interest was surgical site infection (overall; deep; superficial), the incidence of bacteria causative organisms, and the post-operative duration of surgical site occurrence. Follow-up occurred on days 5, 14, and 30 post-operation. The results revealed significantly lower rates of surgical site infection, particularly superficial infection, in the povidone-iodine group. Moreover, the incidences of surgical site infection rate and bacteria-causative organisms in the lumbosacral region were significantly lower in the povidone-iodine group. The results suggest that a povidone-iodine solution could provide significantly better infection prophylaxis over a gentamicin-based solution for patients undergoing open surgery. The findings are particularly relevant to non-Western countries, as this study was conducted in Nigeria.
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