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Efficacy of Dilute Betadine Solution Irrigation in the Prevention of Postoperative Infection of Spinal Surgery

Cheng, Ming-Te MD; Chang, Ming-Chau MD; Wang, Shih-Tien MD; Yu, Wing-Kwang MD; Liu, Chien-Lin MD; Chen, Tain-Hsiung MD

doi: 10.1097/01.brs.0000171907.60775.85
Randomized Trial

Study Design. Prospective, single-blinded, randomized study.

Objectives. To evaluate the efficacy of dilute betadine irrigation of spinal surgical wounds in prevention of postoperative wound infection.

Summary and background. Deep wound infection is a serious complication of spinal surgery that can jeopardize patient outcomes and increase costs. Povidoneiodine is a widely used antiseptic with bactericidal activity against a wide spectrum of pathogens, including methicillin-resistant Staphylococcus aureus. The aim of this study was to evaluate the efficacy of dilute betadine solution in the prevention of wound infection after spinal surgery.

Methods. Four hundred and fourteen patients undergoing spinal surgery were randomly assigned to two groups. In group 1 (208 patients), surgical wounds were irrigated with dilute betadine solution (3.5% betadine) before wound closure. Betadine irrigation was not used in group 2 (206 patients). Otherwise, perioperative management was the same for both groups.

Results. Mean length of follow-up was 15.5 months in both groups (range, 6–24 months). No wound infection occurred in group 1. One superficial infection (0.5%) and six deep infections (2.9%) occurred in group 2. The differences between the deep infection rate (P = 0.0146) and total infection rate (P = 0.0072) were significant between the two groups.

Conclusions. Our report is the first prospective, single-blinded, randomized study to evaluate the clinical effectiveness of dilute betadine solution irrigation for prevention of wound infection following spinal surgery. We recommended this simple and inexpensive measure following spinal surgery, particularly in patients with accidental wound contamination, risk factors for wound infection, or undergoing surgery in the absence of routine ultraviolet light, laminar flow, and isolation suits.

A prospective, single-blinded, randomized study was performed to evaluate the efficacy of topical betadine solution for prevention of infection after spinal surgery. Dilute betadine solution irrigation before wound closure significantly reduced the postoperative infection rate. We conclude that betadine solution irrigation is effective for prevention of infection following spinal surgery.

From the Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital; and the Department of Surgery, School of Medicine, National Yang-Ming University Taipei, Taiwan

Acknowledgment date: January 17, 2004. First revision date: June 18, 2004. Second revision date: August 16, 2004. Acceptance date: September 7, 2004.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and requests for reprints to Ming-Chau Chang, MD, Department of Orthopaedic Spinal Surgery, Taipei Veterans General Hospital No. 201, Sec 2, Shi-Pai Rd., Taipei, Taiwan; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.