Skin Antisepsis before Surgical Fixation of Extremity Fractures
Document Type
Article
Publication Date
2-1-2024
Publication Title
The New England Journal of Medicine
Abstract
BACKGROUND: Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured limb (i.e., an extremity fracture). METHODS: In a cluster-randomized, crossover trial at 25 hospitals in the United States and Canada, we randomly assigned hospitals to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) as preoperative antisepsis for surgical procedures to repair extremity fractures. Every 2 months, the hospitals alternated interventions. Separate populations of patients with either open or closed fractures were enrolled and included in the analysis. The primary outcome was surgical-site infection, which included superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications. RESULTS: A total of 6785 patients with a closed fracture and 1700 patients with an open fracture were included in the trial. In the closed-fracture population, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (odds ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00; P = 0.049). In the open-fracture population, surgical-site infection occurred in 54 patients (6.5%) in the iodine group and in 60 patients (7.3%) in the chlorhexidine group (odd ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45). The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups. CONCLUSIONS: Among patients with closed extremity fractures, skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in alcohol. In patients with open fractures, the results were similar in the two groups. (Funded by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research; PREPARE ClinicalTrials.gov number, NCT03523962.).
First Page
409
Last Page
420
PubMed ID
38294973
Volume
390
Issue
5
Recommended Citation
Sprague, Sheila; Slobogean, Gerard; Wells, Jeffrey L.; O'Hara, Nathan N.; Thabane, Lehana; Mullins, C Daniel; Harris, Anthony D.; Wood, Amber; Viskontas, Darius; Apostle, Kelly L.; O'Toole, Robert V.; Joshi, Manjari; Johal, Herman; Al-Asiri, Jamal; Hymes, Robert A.; Gaski, Greg E.; Pilson, Holly T.; Carroll, Eben A.; Babcock, Sharon; Halvorson, Jason J.; Romeo, Nicholas M.; Matson, Christopher A.; Higgins, Thomas F.; Marchand, Lucas S.; Bergin, Patrick F.; Morellato, John; Van Demark, Robert E. III; Potter, G David; Zura, Robert D.; and al, et, "Skin Antisepsis before Surgical Fixation of Extremity Fractures" (2024). School of Medicine Faculty Publications. 2461.
https://digitalscholar.lsuhsc.edu/som_facpubs/2461
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