Efficacy of Prophylactic Intraoperative Povidone-Iodine Solution Irrigation in Preventing Surgical Site Infection Following Spinal Surgery

  • Imran Altaf khawja safdar medical college sialkot
  • Ammara Liaqat Department of Neurosurgery, Khawaja Muhammad Safdar Medical College, Sialkot
  • Manzoor Ahmad Department of Neurosurgery, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan

Abstract

Objective:  Deep wound infection can worsen clinical outcome and increase costs following spinal surgery. The bactericidal activity of povidone-iodine covers a broad spectrum of pathogens including methicillin-resistant Staphylococcus aureus. Our study aimed at evaluating the role that intraoperative dilute povidone-iodine solution irrigation could play in preventing post-operative wound infection following spinal surgery.

Material and Methods:  The clinical data of 41 patients that had undergone posterior spinal surgery in the department of neurosurgery Allama Iqbal hospital Sialkot was retrospectively analyzed. We divided the patients into two groups. In group 1patients wounds were irrigated with 0.35% povidone-iodine solution prior to closure. In group 2 patients wounds were irrigated with normal saline only. The two groups were then compared for evaluation of efficacy of peroperative povidone-iodine solution irrigation in preventing post-operative wound infection.

Results:  No infection occurred in the 16 patients in group 1 in whom wounds had been irrigated with povidone-iodine solution, compared to 3 deep infections developing in the 25 patients in group 2 in whom wounds had been irrigated with normal saline only. In the 3 patients that suffered from deep infections the duration of hospital stay was also significantly increased (P < 0.05).

Conclusion:  Our study supports the notion that perioperative povidone-iodine irrigation is an effective adjunct measure for prevention of surgical site infection following spinal surgical interventions.

References

1. Fang-Yeng Chang, Ming-Chau Chang, Shih-Tien Wang, Wing-Kwang Yu, Chien-Lin Liu, and Tain-Hsiung Chen. Can povidone-iodine solution be used safely in a spinal surgery? Eur Spine J. 2006 Jun; 15(6): 1005–1014. doi: 10.1007/s00586-005-0975-6

2. Abhijit Yuvaraj Pawar, Samar Kumar Biswas. Postoperative Spine Infections. Asian Spine J. 2016 Feb; 10(1): 176–183. doi: 10.4184/asj.2016.10.1.176

3. Jad Chahoud, Zeina Kanafani, and Souha S. Kanj. Surgical Site Infections Following Spine Surgery: Eliminating the Controversies in the Diagnosis. Front Med (Lausanne). 2014; 1: 7. doi: 10.3389/fmed.2014.00007

4. Vishal Hegde, Dennis S Meredith, Christopher K Kepler, and Russel C Huang. Management of postoperative spinal infections. World J Orthop. 2012 Nov 18; 3(11): 182 189. doi: 10.5312/wjo.v3.i11.182

5. Wen Wei Gerard Ee, Wen Liang Joel Lau, William Yeo, Yap Von Bing, Wai Mun Yue. Does Minimally Invasive Surgery Have a Lower Risk of Surgical Site Infections Compared With Open Spinal Surgery? Clin Orthop Relat Res. 2014 Jun; 472(6): 1718–1724. doi: 10.1007/s11999-013-3158-5

6. Robert W. Molinari, Oner A. Khera, and William J. Molinari III. Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period. Eur Spine J. 2012 Jun; 21(Suppl 4): 476–482. doi: 10.1007/s00586-011-2104-z

7. Cheng MT, Chang MC, Wang ST, Yu WK, Liu CL, Chen TH. Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine (Phila Pa 1976). 2005 Aug 1;30(15):1689-93.

8. Salman Sharif, Farhan Gulzar. Postoperative Infections of the Spine. WScJ. 2015; 1: 19-26.

9. J. J. P. Schimmel, P. P. Horsting, M. de Kleuver, G. Wonders, J. van Limbeek. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J. 2010 Oct; 19(10): 1711–1719. doi: 10.1007/s00586-010-1421-y

10. Veeravagu A, Patil CG, Lad SP, Boakye M. Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine (Phila Pa 1976). 2009 Aug 1;34(17):1869-72. doi: 10.1097/BRS.0b013e3181adc989.

11. Calderone RR, Garland DE, Capen DA, Oster H. Cost of medical care for postoperative spinal infections. Orthop Clin North Am. 1996 Jan;27(1):171-82.


12. De Luna V, Mancini F, De Maio F, Bernardi G, Ippolito E, Caterini R. Intraoperative Disinfection by Pulse Irrigation with Povidone-Iodine Solution in Spine Surgery. Adv Orthop. 2017;2017:7218918. doi: 10.1155/2017/7218918.

13. Ulivieri S, Toninelli S, Petrini C, Giorgio A, Oliveri G. Prevention of post-operative infections in spine surgery by wound irrigation with a solution of povidone-iodine and hydrogen peroxide. Arch Orthop Trauma Surg. 2011 Sep;131(9):1203-6. doi: 10.1007/s00402-011-1262-0.
Published
2021-03-31
Section
Original Article