Evidence map›Paper›PMID 40779037›Full record

SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025

RCT-based meta-analysis of povidone-iodine irrigation in spinal surgery: clarifying efficacy and safety.

Chinedu Egu, Rodrigo Muscogliati, Weronika Nocun, Hussein Akil, Wasse U Saleh, Babajide Obidigbo, Rebecca Aida Hakim, Nasir A Quraishi, Khalid Salem, Elie Najjar

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Chinedu EguThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK. chinedu.brian.egu@gmail.com.
Rodrigo MuscogliatiThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.
Weronika NocunThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.
Hussein AkilThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.
Wasse U SalehThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.
Babajide ObidigboThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.
Rebecca Aida HakimThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.
Nasir A QuraishiThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.
Khalid SalemThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.
Elie NajjarThe Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, NG7 2UH, Nottingham, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSurgical site infections (SSIs) remain a significant complication in spinal surgery, particularly in instrumented procedures, contributing to increased morbidity, prolonged hospitalization, and healthcare costs. Intraoperative wound irrigation (IWI) using antiseptic solutions such as povidone-iodine (PI) has been proposed as a preventive strategy. This systematic review and meta-analysis evaluate the efficacy of PI irrigation against control interventions, in reducing postoperative SSIs and examines its effect on spinal fusion outcomes.

methodsFollowing PRISMA guidelines, a comprehensive search of Ovid MEDLINE, EMBASE, Web of Science, and the Cochrane Library was conducted through March 2025. Only randomized controlled trials (RCTs) comparing PI irrigation to control interventions (saline or no irrigation) in adult spinal surgery were included. The primary outcome was overall SSI rate. Secondary outcomes included superficial and deep SSI rates, fusion rates, and adverse events. Data were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic.

resultsSix RCTs involving 1,804 patients (901 PI group, 903 control group) were included. Pooled analysis demonstrated a significant reduction in overall SSI with PI irrigation (0.77% vs. 6.0%; RR = 0.16, 95% CI: 0.08-0.34; P < 0.00001; I² = 0%). Subgroup analyses showed significant reductions in both superficial (RR = 0.19; 95% CI: 0.07-0.52; P < 0.001) and deep SSIs (RR = 0.21; 95% CI: 0.08-0.52; P = 0.0009), with absolute infection rates reduced from 2.9 to 0.33% and from 3.2 to 0.4%, respectively. Fusion rates were comparable between groups (RD = 0.03; 95% CI: 0.00-0.06; P = 0.10).

conclusionPI irrigation significantly lowers the risk of both superficial and deep SSIs in spinal surgery without negatively impacting fusion outcomes. These findings are based on Level I evidence and support the integration of PI irrigation into routine perioperative protocols as a low-cost, effective adjunct for infection prevention.

Indexed as

Anti-Infective Agents, LocalPovidone-IodineSpinal FusionSpineSurgical Wound InfectionTherapeutic IrrigationHumansRandomized Controlled Trials as TopicAnti-Infective Agents, LocalPovidone-IodineComplicationsInfection prophylaxisIntraoperative wound irrigationPovidone iodineSpine fusionSpine surgerySurgical site infection

Identifiers

PMID40779037

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.