Betadine irrigation and post-craniotomy wound infection

The purpose of this study is to evaluate the efficacy of betadine irrigation in preventing postoperative wound infection in cranial neurosurgical procedures.

A total of 473 consecutive cranial neurosurgical procedures, including craniotomies and burr hole procedures were retrospectively reviewed. Patients had either antibiotic irrigation or dilute betadine plus antibiotic irrigation prior to skin closure. Infection was determined by purulence noted on reoperation and confirmed with bacterial growth culture. One and three month postoperative infection rates were calculated. Statistical analysis was performed using Chi-squared tests.

This study included 404 patients. Betadine was used in 117 (29.0%). At 1 month after surgery, there was no difference in the rate of wound infection between the two groups (1.7% each). However, at 90 days, the betadine group had a 2.6% infection rate compared with 3.8% in the antibiotic group, indicating a 33% decrease in infection rates with the addition of betadine (p=.527). The small sample size of the study produced a low power and high beta error.

In this small preliminary study, betadine decreased postoperative infection rates compared with antibiotic prophylaxis alone at 90 days but not 30 days. This was not statistically significant, but a larger sample size would lower the beta error and decrease confounding bias associated with group heterogeneity. The potential for betadine, a cheap, low toxicity antimicrobial, to decrease infection rates and reoperations for infection warrants a larger multicenter trial.