Propensity-matched analysis of the efficacy of olanexidine gluconate versus chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy

Abstract

Background In the present matched-cohort study, we investigated the efficacy of olanexidine gluconate in comparison with chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy. Methods A total of 372 patients with esophageal cancer who were scheduled to undergo thoracic esophagectomy between 2016 and 2018 were assigned to one of two groups based on the preoperative antiseptic agent used in thoracic esophagectomy. We investigated the incidence of surgical site infectious complications in the propensity-matched cohort. Results Based on the propensity score, 116 patients prepared with 1.5% olanexidine gluconate and 114 patients prepared with 1.0% chlorhexidine-alcohol as surgical skin antisepsis were selected. No significant intergroup differences were observed with respect to incisional surgical site infection (0.8% in the olanexidine group versus 0.8% in the chlorhexidine group) and deep fascial/organ space surgical site infection (1.7%/10.3% in the olanexidine group versus 3.5%/15.7% in the chlorhexidine group, p = 0.39/p = 0.03). Notably, the respective incidences of surgical site infection except anastomotic leakage were 1.7% and 7.0% in the olanexidine and chlorhexidine groups (p = 0.04). Conclusions Olanexidine gluconate was well tolerated and significantly reduced incidence of surgical site infection except anastomotic leakage in comparison with chlorhexidine-alcohol as an antiseptic agent in thoracic esophagectomy with three-field lymph node dissection.

Comparison of olanexidine versus povidone‐iodine as a preoperative antiseptic for reducing surgical site infection in both scheduled and emergency gastrointestinal surgeries: A single‐center randomized clinical trial

“…9 Fujita et al first reported a comparative study using propensity score matching analysis between 1.5% olanexidine and 1.0% chlorhexidine in thoracic esophagectomy; however, the study could not demonstrate any significant differences in SSI incidences. 10 This study could not demonstrate any significant decrease in 30-day SSI incidence; however, a significant reduction in organ/space SSI incidence was observed (p = 0.049).…”

“…In contrast, two negative propensity score matching studies regarding olanexidine have been conducted; Kojima et al found no significant difference in SSI incidence in patients undergoing colorectal surgery compared with to 10% povidone‐iodine (8.6% vs. 8.6%, p = 1.000) 9 . Fujita et al first reported a comparative study using propensity score matching analysis between 1.5% olanexidine and 1.0% chlorhexidine in thoracic esophagectomy; however, the study could not demonstrate any significant differences in SSI incidences 10 . This study could not demonstrate any significant decrease in 30‐day SSI incidence; however, a significant reduction in organ/space SSI incidence was observed ( p = 0.049).…”

“…In addition, some prospective and retrospective comparative studies have been conducted on gastrointestinal surgery. [7][8][9][10][11] However, the indications of all studies are limited to clean-contaminated (operative wound class II) gastrointestinal surgery. To clarify the true superiority of 1.5% olanexidine, we conducted a randomized prospective clinical trial to enroll patients undergoing gastrointestinal surgery with operative wound classes II-IV, including emergency surgery.…”

“…Recently, 1.5% olanexidine (Olanedine; Otsuka Pharmatceutical Factory, Tokushima, Japan) has been commercially available as a preoperative antiseptic in Japan. In addition, some prospective and retrospective comparative studies have been conducted on gastrointestinal surgery 7–11 . However, the indications of all studies are limited to clean–contaminated (operative wound class II) gastrointestinal surgery.…”

Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis

“…To our knowledge, except for a randomised trial by Obara and colleagues, 8 only non-randomised studies have been conducted on olanexidine. 67,68 Furthermore, the study by Obara and colleagues has an important methodological limitation. In the published protocol, an adjusted RR (ARR) with 95% CI was planned, but the final analysis was done by calculating an ARR with 90% CI.…”