Preoperative chlorhexidine versus povidone-iodine antisepsis for preventing surgical site infection: A Meta-analysis and trial sequential analysis of randomized controlled trials

Abstract Backgrounds Updated guidelines for surgical site infections (SSIs) suggested that chlorhexidine (CH) or povidone-iodine (PVI) product was equally appropriate to be applied in preoperative disinfection, but which one was optimal remained ambiguous. Moreover, recent studies reported inconsistent results. Thus, an updated meta-analysis was conducted to clarify the superiority of CH or PVI for prevention of SSIs in clean and clean-contaminated surgery. Methods From the inception to November 2016, Pubmed, Embase, and the Cochrane library were systematically searched for randomized controlled trials (RCTs) which explored preoperative antisepsis schemes (CH or PVI) for prevention of SSIs in clean and clean-contaminated surgery. Relative risks (RRs) with 95% confidence interval (CI) were calculated using random effects model. Furthermore, subgroup analysis, sensitive analysis, and trial sequential analysis (TSA) were applied to estimate whether overall pooled effect was enough credible and robust. Results Thirteen RCTs involving 6997 patients (3352 in CH and 3645 in PVI group) undergoing clean and clean-contaminated surgeries were included in our meta-analysis. Compared with PVI, preoperative CH antisepsis was associated with lower incidence of SSIs (RR, 0.70; 95%CI, 0.60-0.83, I2 =0). Additionally, subgroup analysis, sensitive analysis, and TSA indicated that the current available evidence was reliable and robust. Conclusions CH should be more preferentially recommended for preoperative skin preparation as compared with PVI in clean and clean-contaminated surgery.