A comparative meta-analysis of povidone–iodine–alcohol vs. chlorhexidine–alcohol for preoperative skin antisepsis in abdominal surgery

Abstract

Introduction

Abdominal surgeries are among the most frequently performed procedures globally and exhibit higher surgical site infection (SSI) rates, with associated complications significantly impacting morbidity and mortality. While alcohol-based antiseptics effectively reduce SSIs, debate persists over the relative efficacy of chlorhexidine–alcohol versus iodine–alcohol solutions. This meta-analysis systematically compares SSI rates in abdominal surgeries using these antiseptics, aiming to inform optimal preoperative practices.

Methods

A comprehensive search was conducted across the Cochrane Library, Embase, and MEDLINE databases to identify relevant studies. Meta-analysis was performed using the metafor package in R software, wherein risk ratios (RRs) for surgical site infections (SSIs) were compared between chlorhexidine–alcohol and iodine–alcohol groups in patients undergoing abdominal surgeries. Subgroup analyses were conducted based on wound classification and procedural categories, including general surgery and obstetrics/gynecology. A random-effects model was utilized, with effect sizes presented alongside their 95 ​% confidence intervals (CIs).

Results

Our meta-analysis included 10 randomized controlled trials and found no significant difference in SSI risk between chlorhexidine–alcohol and iodine–alcohol in abdominal surgeries (RR, 1.20; 95 ​% CI, 0.94–1.54). Subgroup analyses for general surgery, obstetrics/gynecology, and clean-contaminated wounds also showed no significant differences between antiseptics.

Conclusion

This meta-analysis indicates no significant difference in SSI incidence between chlorhexidine–alcohol and iodine–alcohol as preoperative antiseptics for abdominal surgeries.