{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:55:29Z","timestamp":1791305729235,"version":"4.3.1"},"reference-count":19,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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\u20131.58; p = 0.578) or the lumbar cohort (3.17% vs. 3.29%; RR 0.96, 95% CI 0.76\u20131.22; 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.<\/jats:p>","DOI":"10.3390\/jcm15197714","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:21:46Z","timestamp":1791303706000},"page":"7714","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"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"],"prefix":"10.3390","volume":"15","author":[{"given":"Firas","family":"Batrash","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2910-756X","authenticated-orcid":false,"given":"Fahad","family":"Jamal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Siddharth","family":"Jasti","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4436-6422","authenticated-orcid":false,"given":"James A.","family":"Belanger","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, 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USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4769-086X","authenticated-orcid":false,"given":"Tasif","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Ahmed","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9978-6694","authenticated-orcid":false,"given":"Artin","family":"Allahverdian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Bryce A.","family":"Basques","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9597-4139","authenticated-orcid":false,"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Avenue, East Providence, RI 02914, 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Spine J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7714\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:24:34Z","timestamp":1791303874000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7714"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":19,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197714"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197714","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]}}}