Effectiveness of surgical skin preparation solutions in orthopaedic surgery: A systematic review of the current comparative literature

Table 5 Surgical skin preparation demographics and results of studies evaluating spine surgery

Ref.	Level of evidence	Surgery type	Sample size (n)	Interventions	Comparisons	Key findings
Dromzee et al[52], 2012, France	Randomized clinical trial (level 1)	Pediatric scoliosis	56	Cyanoacrylate liquid (N/A); no cyanoacrylate liquid	Comparison of surgical site infection	No statistically significant difference in surgical site infection
Ghobrial et al[53], 2018, United States	Prospective cohort (level 2)	All spine cases	6959	2% chlorhexidine gluconate and 70% isopropyl alcohol (S); 7.5% povidone iodine solution (P)	Comparing culture rates and surgical site infections	There was no statistically significant difference between cohorts for culture growth or surgical site infections
Madariaga et al[54], 2024, United States	Retrospective comparative study (level 2)	Cervical spine	86	0.7% iodine povacrylex in 74% isopropyl alcohol (S); 0.77% iodine povacrylex in 74% isopropyl alcohol and 3% hydrogen peroxide (S)	Comparing post prep C. acnes culture and surgical site infection	There was no statistically significant difference in culture rate between cohorts
Savage et al[55], 2012, United States	Randomized control trial (level 1)	Lumbar spine surgery	100	2% chlorhexidine gluconate in 70% isopropyl alcohol (S); 0.7% available iodine in 74% isopropyl alcohol (S)	Comparing post prep culture rates and surgical site infection	There was no statistically significant difference in positive culture rate between cohorts
Yoshii et al[56], 2018, Japan	Prospective comparative study (level 2)	Posterior spine surgery	190	0.5% chlorhexidine in 79% ethanol (S); 10% povidone iodine (P)	Comparing culture rate and surgical site infection	There was no significant difference in culture rates immediately after skin preparation (P = 0.49); the positive culture rate after wound closure was significantly lower in the chlorhexidine group than the iodine group (P = 0.046)

N/A: Not applicable; S: Stick application; P: Paint application; C. acnes: Cutibacterium acnes.