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The following is a summary of “A Comparative Meta-Analysis of Povidone–Iodine–Alcohol vs. Chlorhexidine–Alcohol for Preoperative Skin Antisepsis in Abdominal Surgery,” published in the March 2025 issue of American Journal of Surgery by Hsieh et al. 

Abdominal surgeries constitute a significant proportion of surgical procedures performed worldwide and are associated with an elevated risk of surgical site infections (SSIs), which contribute substantially to postoperative complications, increased morbidity, extended hospital stays, and in severe cases, mortality. Given the critical importance of effective preoperative skin antisepsis in minimizing SSIs, alcohol-based antiseptic solutions are widely endorsed; however, there remains ongoing debate regarding the comparative effectiveness of chlorhexidine–alcohol versus iodine–alcohol preparations. This meta-analysis was undertaken to provide a comprehensive evaluation of existing evidence, focusing on the relative efficacy of these two antiseptics in reducing SSI rates specifically within the context of abdominal surgery.

A thorough literature search was conducted across three major databases—MEDLINE, Embase, and the Cochrane Library—to identify randomized controlled trials that directly compared chlorhexidine–alcohol and iodine–alcohol solutions in abdominal surgical settings. Data synthesis was performed using the metafor package in R software, applying a random-effects model to account for heterogeneity among studies. The primary outcome assessed was the incidence of SSIs, reported as RRs with corresponding 95% CIs. Subgroup analyses were also conducted to evaluate outcomes across different surgical categories, including general surgery and obstetrics/gynecology, as well as based on wound classification, particularly clean-contaminated wounds. 

A total of 10 randomized controlled trials met the inclusion criteria for this analysis. The pooled results demonstrated no statistically significant difference in SSI risk between the chlorhexidine–alcohol and iodine–alcohol groups in abdominal surgeries overall (RR, 1.20; 95% CI, 0.94–1.54). Similarly, subgroup analyses yielded consistent findings, showing no significant differences in SSI outcomes between the two antiseptic regimens across various procedural types and wound classifications. These findings suggest that both chlorhexidine–alcohol and iodine–alcohol solutions offer comparable levels of protection against SSIs in abdominal surgical patients. Importantly, the lack of significant difference highlights the potential for flexibility in clinical antiseptic selection, allowing surgical teams to consider additional factors such as cost, availability, patient allergies, and institutional protocols when choosing preoperative antiseptics. 

In conclusion, this meta-analysis provides evidence that there is no clear superiority of one alcohol-based antiseptic solution over the other in the context of abdominal surgery, supporting the continued use of either agent as part of standardized infection prevention strategies. Further high-quality studies may help refine antiseptic recommendations in specific surgical subgroups, but current evidence supports the equivalence of chlorhexidine–alcohol and iodine–alcohol in this clinical setting.

Source:americanjournalofsurgery.com/article/S0002-9610(25)00140-0/abstract