López-Cano Manuel, Kraft Miquel, Curell Anna, Puig-Asensio Mireia, Balibrea José, Armengol-Carrasco Manuel, García-Alamino Josep M
Department of General Surgery, Abdominal Wall Surgery Unit and General and Digestive Surgery Research Group, Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
World J Surg. 2019 Feb;43(2):374-384. doi: 10.1007/s00268-018-4798-0.
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.
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).
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 = 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 = 51%) and was only significant in clean wounds (RR 0.25, 95% CI 0.09-0.70, P = 0.008, I = 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, the accrued information size (n = 4322) was 32.8% of the estimated optimal information size (n = 13,148).
There is no conclusive evidence for a strong recommendation of topical PVI before wound closure to prevent SSI.
聚维酮碘（PVI）是外科医生广泛使用的一种消毒溶液。进行了一项基于随机对照试验（RCT）的荟萃分析，以确定伤口闭合前应用PVI是否可降低手术部位感染（SSI）率。
系统检索MEDLINE/PubMed、Scopus、CINAHL和Web of Science数据库，检索时间从建库至2017年9月，无语言限制。仅检索RCT。主要结局为SSI率。荟萃分析辅以试验序贯分析（TSA）。
共分析了从16项RCT中收集的7601例患者。发现总体SSI率有所降低（RR 0.64，95%CI 0.48 - 0.85，P = 0.002，I = 65%），这归因于接受择期手术的患者（n = 2358）和择期/急诊混合手术的患者（n = 2019）。排除质量不确定的RCT（n = 9）后，伤口闭合前使用PVI（n = 4322例患者）与SSI显著降低无关（RR 0.81，95%CI 0.55 - 1.20，P = 0.29，I = 51%），仅在清洁伤口中具有显著性（RR 0.25，95%CI 0.09 - 0.70，P = 0.008，I = 0%）。对于主要结局，使用19%的相对风险降低率、11%的对照事件发生率（CER）和51%的I进行TSA计算，累积信息量（n = 4322）为估计最佳信息量（n = 13,148）的32.8%。
尚无确凿证据强烈推荐在伤口闭合前局部应用PVI以预防SSI。
