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

source extracted confidence: high 2026-04-09
#humans #abdomen #anti-infective-agents-local #antisepsis #chlorhexidine

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

Hsieh et al., 2025 | Am J Surg | Meta Analysis

Citation

Hsieh Hua-Hsin, Yu Yueh, ... Chang Tzu-Yen. A comparative meta-analysis of povidone-iodine-alcohol vs. chlorhexidine-alcohol for preoperative skin antisepsis in abdominal surgery. Am J Surg. 2025-Jun;244:116318. doi:10.1016/j.amjsurg.2025.116318

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.

Key Findings

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.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 10
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Abdomen
  • Anti-Infective Agents, Local
  • Antisepsis
  • Chlorhexidine
  • Ethanol
  • Povidone-Iodine
  • Preoperative Care
  • Surgical Wound Infection

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Comparative Study, Review
  • Vertical: iodine

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09