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

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.