title: Preoperative chlorhexidine reduces the incidence of surgical site infections in total knee and hip arthroplasty: A systematic review and meta-analysis.
abstract: OBJECTIVE
  This meta-analysis aims to assess the incidences of surgical site infection of patients who applied preadmission chlorhexidine skin preparation, versus those who applied the traditional skin preparation before undergoing total knee and hip arthroplasty.
  
  
  METHODS
  A systematic search is carried out through Medline (1966-2016.11), PubMed (1966-2016.11), Embase (1980-2016.11), ScienceDirect (1985-2016.11) and the Cochrane Library. Only high quality studies are identified. Meta-analysis is conducted with the use of Stata 11.0 software.
  
  
  RESULTS
  One RCT and five retrospective studies, published between 2010 and 2016, are included in the present meta-analysis. The present meta-analysis indicates that there are significant differences in surgical site infection rate (RD = -0.02, 95% CI: -0.02 to -0.01, P < 0.00001), revision surgery rate (RD = -0.01, 95% CI: -0.01 to -0.01, P < 0.00001) and length of stay (MD = -0.29, 95% CI: -0.48 to -0.11, P = 0.002) between groups.
  
  
  CONCLUSIONS
  Preoperative chlorhexidine skin preparation appears to reduce the risk of infection, the incidence of revision surgery, and the length of stay for patients undergoing total knee and hip arthroplasty. No adverse effects, such as DVT or PE, appear to be related to chlorhexidine preparation. Due to the limited quality of the evidence currently available, high quality RCTs with better study designs, larger sample sizes and longer follow-ups are needed.
authors.affiliation: Department of Joint Surgery Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xian, 710054, China.
authors.forename: Yuanzhen
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Department of Joint Surgery Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xian, 710054, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: Department of Joint Surgery Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xian, 710054, China.
authors.forename: Weikun
authors.initials: W
authors.lastname: Hou
authors.affiliation: Department of Joint Surgery Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xian, 710054, China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Joint Surgery Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xian, 710054, China. Electronic address: xupeng1967@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Xu
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D000985:Antisepsis / Q000379:methods; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D002710:Chlorhexidine / Q000627:therapeutic use*; D003428:Cross Infection / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D011300:Preoperative Care / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
keywords: Chlorhexidine; Meta-analysis; Surgical site infection; Total hip arthroplasty; Total knee arthroplasty