Incidence of Skin and Soft Tissue Infection in Elective Foot and Ankle Surgery Utilizing Iodine- vs Chlorhexidine-Based Surgical Skin Preparation: A Retrospective Study.

BACKGROUND Although the incidence of surgical site infection (SSI) in elective orthopedic surgery is low, SSI remains the most common hospital-acquired infection and represents a substantial proportion of nosocomial illness. Elective foot and ankle surgery has been reported to carry a relatively higher risk of SSI compared with other orthopedic procedures. These infections are associated with increased healthcare costs, prolonged recovery, and increased patient morbidity, making perioperative infection prevention a critical aspect of surgical planning.

PURPOSE To compare postoperative surgical site infection rates following elective foot and ankle surgery using alcohol-based chlorhexidine versus alcohol-based iodine skin antiseptic agents.

STUDY DESIGN Single-Surgeon, Retrospective Review.

METHODS A total of 215 consecutive patients undergoing clean, elective foot and ankle surgery were included. Patients were divided into two cohorts based on the preoperative skin preparation used: chlorhexidine-based preparation (n = 116) or iodine-based preparation (n = 99). Postoperative infection rates were recorded. Categorical variables, including infection, were compared using Fisher's exact test, and continuous variables were analyzed using independent-samples t-tests.

RESULTS Postoperative infection occurred in 1.72% of patients in the chlorhexidine-based group and 1.02% of patients in the iodine-based group. No statistically significant difference was observed between groups.

CONCLUSION In this retrospective cohort study, no statistically significant difference in postoperative SSI rates was observed between alcohol-based chlorhexidine and alcohol-based iodine skin preparation agents in elective foot and ankle surgery. Given the low incidence of infection and limited statistical power, these findings should not be interpreted as evidence of equivalence between preparations.

THERAPEUTIC STUDY Level 3 Evidence.