{
  "abstract": "Background/Objectives: Chlorhexidine and iodine-based preparations are both widely used, and the existing literature suggests a possible advantage of chlorhexidine in clean elective surgery. Whether this extends to instrumented degenerative spine surgery is unknown. We asked whether chlorhexidine-based skin preparation reduces 90-day postoperative infection compared with iodine-based preparation after instrumented degenerative cervical or lumbar spine surgery. Methods: A retrospective TriNetX cohort study was performed among adults undergoing instrumented degenerative cervical or lumbar spine surgery. Patients were stratified by anatomic region and by preoperative preparation exposure: chlorhexidine-based versus iodine-based. Moreover, 1:1 propensity-score matching was performed within each anatomic stratum on demographics, Charlson Comorbidity Index (CCI), diabetes, smoking, obesity and BMI, immunosuppression, methicillin-resistant Staphylococcus aureus (MRSA) carrier status, and index procedure codes. The primary outcome was 90-day postoperative infection. Secondary outcomes were superficial and deep surgical site infection, MRSA infection, incision and drainage, debridement, sepsis, urinary tract infection, and pneumonia. Results: After matching, the cervical cohort included 3528 patients per group and the lumbar cohort 4164 per group. Postoperative infection did not differ in the cervical cohort (1.76% vs. 1.59%; risk ratio [RR] 1.11, 95% confidence interval [CI] 0.77–1.58; p = 0.578) or the lumbar cohort (3.17% vs. 3.29%; RR 0.96, 95% CI 0.76–1.22; p = 0.757). Superficial and deep infection, MRSA infection, debridement, sepsis, urinary tract infection, and pneumonia did not differ significantly in either cohort. Conclusions: No statistically significant difference in 90-day postoperative infection was found between chlorhexidine-based and iodine-based skin preparation after instrumented degenerative cervical or lumbar spine surgery.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Firas Batrash"
    },
    {
      "affs": [
        0
      ],
      "name": "Fahad Jamal",
      "orcid": "0009-0005-2910-756X"
    },
    {
      "affs": [
        0
      ],
      "name": "Siddharth Jasti"
    },
    {
      "affs": [
        0
      ],
      "name": "James A. Belanger",
      "orcid": "0009-0008-4436-6422"
    },
    {
      "affs": [
        0
      ],
      "name": "Timothy A. Reiad",
      "orcid": "0009-0003-0408-5259"
    },
    {
      "affs": [
        0
      ],
      "name": "Tasif Mahmoud",
      "orcid": "0009-0004-4769-086X"
    },
    {
      "affs": [
        0
      ],
      "name": "Ahmed Iqbal"
    },
    {
      "affs": [
        0
      ],
      "name": "Artin Allahverdian",
      "orcid": "0009-0008-9978-6694"
    },
    {
      "affs": [
        0
      ],
      "name": "Bassel G. Diebo"
    },
    {
      "affs": [
        0
      ],
      "name": "Bryce A. Basques"
    },
    {
      "affs": [
        0
      ],
      "name": "Alan H. Daniels",
      "orcid": "0000-0001-9597-4139"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/14gy0a6gpzznh.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15197714",
  "fulltext_url": null,
  "id": "14gy0a6gpzznh",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/19/7714",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Surgical site infection prevention"
    ]
  ],
  "openalex": "W7220736962",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-06",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/14gy0a6gpzznh.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15197714",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/19/7714"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Surgical site infection prevention",
      "subfield": "surgery"
    }
  ],
  "title": "Chlorhexidine Versus Iodine-Based Skin Preparation Was Not Associated with a Significant Difference in 90-Day Infection Risk After Instrumented Degenerative Cervical or Lumbar Spine Surgery: A Propensity Score-Matched Analysis",
  "title_text": "Chlorhexidine Versus Iodine-Based Skin Preparation Was Not Associated with a Significant Difference in 90-Day Infection Risk After Instrumented Degenerative Cervical or Lumbar Spine Surgery: A Propensity Score-Matched Analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:00Z",
  "url": "https://research.draconitic.com/paper/14gy0a6gpzznh",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}