Preoperative Chlorhexidine Versus Povidone-iodine Antisepsis For Preventing Surgical Site Infection:A Meta-analysis And Trial Sequential Analysis Of Randomized Controlled Trials

Background:Updated guidelines for surgical site infections(SSIs)suggested that chlorhexidi-ne(CH)or povidone-iodine(PVI)was equally appropriate to be applied in preopera-tive disinfection,but which one was optimal remained ambiguous.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 searched for randomized controlled trials(RC Ts)which explored preoperative antisepsis scheme(C H or PVI)for prevention of SSIs.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 RC Ts 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,I~2 = 0).Additionally,subgroup analysis,sensitive analysis,and TSA indicated that the current available evidence was reliable and robust.Conclusion:CH should be more preferentially recommended for preoperative sk in preparation as compared with PVI in clean and clean-contaminated surgery.