Prospective comparative evaluation of povidone-iodine sitz bath and silver-based antimicrobial spray in postoperative perianal wound care: impact on healing outcomes, patient satisfaction, and treatment compliance

Abstract

Perianal surgical wounds are likely to take longer to heal and get infected due to constant contamination, moisture and pain during defecation. Povidone-iodine has long been applied in the postoperative treatment, and silver-based agents have become an alternative with an excellent antimicrobial effect and patient-friendly characteristics. This study was intended to compare the outcomes on postoperative perianal wound-healing between the application of povidone-iodine sitz bath and silver-based antimicrobial spray, with additional evaluation of patient satisfaction and treatment compliance with the assigned wound care regimen. It is a hospital-based observational study conducted over a period of 4 months in a tertiary care centre. A total of one hundred patients subjected to surgery for haemorrhoids, fissure in ano, or fistula in ano were recruited and split into two equal groups. Group A received a povidone-iodine sitz bath, and Group B received a silver-based antimicrobial spray. The main outcome was time to heal wounds. The secondary outcomes were postoperative pain (VAS), patient satisfaction score (PSS), treatment compliance index (TCI), and wound-related complications. Statistical significance was set at p < 0.05. Baseline characteristics were comparable among groups. Mean wound-healing time was significantly shorter in the povidone-iodine cohort (14.2 ± 3.1 days) compared to the silver group (16.8 ± 3.6 days; p = 0.001). Surgical site infection was lower with povidone-iodine (6% vs. 18%; p = 0.048). Silver-based spray was associated with significantly lower postoperative pain scores, higher patient satisfaction scores (composite PSS: 7.9 ± 0.9 vs. 6.5 ± 1.1; p < 0.001), and superior treatment compliance at both Week 2 (92.1% vs. 74.2%; p < 0.001) and Week 4 (88.4% vs. 66.8%; p < 0.001). Wound-related complications were more frequent in the silver cohort. Povidone-iodine sitz bath provides superior healing and infection control, whereas silver-based antimicrobial spray significantly improves postoperative comfort, patient satisfaction, and treatment compliance highlighting the importance of patient-centred factors in wound care selection following perianal surgery.