Publication:

A comparative study to determine the incidence of post-operative wound infection in primary orthopaedics surgery with betasaline and normal saline intraoperative wound irrigation

Background Orthopaedic surgeries are susceptible to surgical site infections (SSIs) that highly contribute to postoperative morbidity and cost of health care. The importance of wound irrigation is a preventive measure, which is critical, yet the relative effectiveness of antiseptic solutions and regular saline should be assessed further. This study aimed to compare the incidence of postoperative wound infection and the general tissue healing of intraoperative betasaline (diluted povidone-iodine) with normal saline irrigation during primary orthopaedic surgeries.

Methods A comparative study was done over 21 months on 200 adult patients undergoing primary orthopaedic surgeries. Group A (betasaline, n=100) and group B (normal saline, n=100), were randomized equally. The Southampton wound grading system was used to assess postoperative wounds on day (POD) 2, 7, 14 and 30.

Results Baseline demographics were similar. Grade 3 changes (serous discharge) occurred in 4% (n=4) of the normal saline cohort on POD 2 compared to 0% grade 3 or grade 4 changes in the betasaline cohort. More importantly, grade 4 SSIs (purulent discharge) were not developed by either group. At POD 7, 50 per cent (n=50) patients in the betasaline group had grade 1 healing, as compared to 46 per cent (n=46) patients in the normal saline group. By POD 30, 100% of participants in both groups had achieved complete wound healing (grade 0). There were only minor, localized skin reactions in 6% (n=6) of the betasaline group with no systemic adverse effects observed.

Conclusions Betasaline and normal saline are good agents of ensuring satisfactory wound healing. Nonetheless, intraoperative irrigation with betasaline shows a very promising clinical pattern of reducing early postoperative infections and speeding up the healing of tissue inflammation with an acceptable safety profile.