Anesthesiology May 2024, Vol. 140, A13–A15.
Skin antisepsis before surgical fixation of extremity fractures. N Engl J Med 2024; 390:409–20. PMID: 38294973.
Conflicting results have been reported with respect to the type of skin antisepsis used prior to surgical incision to repair limb fractures with regard to the development of postoperative surgical-site infections. This cluster-randomized crossover trial (25 Canadian and U.S. hospitals) randomly assigned hospitals to either 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) for antisepsis for surgical repair of extremity fractures with hospitals alternating interventions every 2 months. Analyses were stratified by open versus closed fractures. The primary outcome was surgical-site infections (superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days after surgery). The secondary outcome was unplanned reoperation for fracture-healing complications. Enrollment included 8,485 patients (6,785 closed, 1,700 open fracture). With closed fracture, the primary outcome was significantly different between groups (2.4% iodine vs. 3.3% chlorhexidine; odds ratio, 0.74; 95% CI, 0.55 to 1.00; P = 0.049), while in the open-fracture group no difference was noted (6.5% vs. 7.3%; odds ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45). No differences in the secondary outcome, 1-yr outcome, or adverse events between antisepsis groups were noted in either type of fracture population.
Take home message: This multicenter, cluster-randomized trial of iodine povacrylex versus chlorhexidine gluconate skin antisepsis prior to surgical incision for repair of extremity fractures noted a small but statistically significant difference in surgical-site infections in patients with closed, but not open fractures.