Vaginal Antisepsis for Major Gynecologic Surgeries Using Chlorhexidine Gluconate versus Povidone Iodine: A Systematic Review and Meta-Analysis
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OBJECTIVE
We performed a systematic review and meta-analysis (SRMA) of post-surgical outcomes, comparing chlorhexidine gluconate (CHG) versus povidone iodine (PI) for vaginal antisepsis of major gynecologic procedures.
DATA SOURCES
Ovid Medline, Embase, Scopus, Embase, Cochrane, and Clinicaltrials.gov were searched between 1986 and December 2023, for studies comparing CHG with PI for vaginal antisepsis of major gynecologic operations.
STUDY ELIGIBILITY CRITERIA
We included Randomized Controlled Trials (RCTs) and non-RCTs comparing CHG to PI for vaginal antisepsis of major gynecologic operations. The primary outcome was surgical site infections (SSIs) and the secondary outcome was urinary tract infections (UTIs) and vaginal irritation.
METHODS
Summary estimates were calculated by fixed effects models when I 2 ≤ 25% and by random effects models when I 2 > 25%. Statistical analysis was performed using RevMan 5.4.1. The protocol for this systematic review was registered on PROSPERO (ID CRD42022378101).
RESULTS
Nine studies met the inclusion criteria, four of which were randomized controlled trials (RCTs). 9538 patients were included, 4300 (45%) of whom were allocated to CHG and 5238 (55%) to PI. No statistically significant difference in SSI incidence was found for vaginal antisepsis with CHG versus PI in pooled analyses (n= 9538 patients; RR 1.20; 95% CI 0.92-1.57; I 2 =0%). In contrast, a significantly higher risk of UTIs was observed for vaginal antisepsis with CHG than with PI (n=6061 patients; RR 1.48 95% CI 1.03-2.14; I 2 = 0%).
CONCLUSION
In our SRMA, there were no significant differences in SSI risk when either CHG or PI was utilized for antiseptic vaginal preparation. Interestingly, vaginal antisepsis with PI was associated with a lower incidence of post-operative UTIs following major gynecologic surgery. Our findings support current guidelines that form of vaginal antisepsis can be used for SSI prevention. They also suggest that PI may result in fewer postoperative UTIs but further randomized studies are needed to support these findings.
CONDENSATION PAGE
Tweetable statement
Our meta-analysis found that chlorhexidine gluconate and povidone iodine are both acceptable for vaginal preparation in major GYN surgery.
AJOG at a Glance
a) Why was this study conducted?
Although vaginal antisepsis is recommended before major gynecologic surgeries, there is no consensus over the preferred vaginal preparation solution.
b) What are the key findings?
Our systematic review and meta-analysis showed that the risk of surgical site infections (SSIs) after major gynecologic surgery was similar following vaginal antisepsis with chlorhexidine gluconate (CHG) and povidone iodine (PI). However, the risk of urinary tract infections (UTIs) was significantly lower following antisepsis with PI.
c) What does this study add to what is already known?
Our findings support current guidelines recommending use of either form of vaginal antisepsis for major gynecologic procedures that require vaginal preparation.
