Hypochlorous acid lavage versus intrawound vancomycin powder for prevention of deep surgical-site infection after major posterior spine surgery: A retrospective case series with a historical control group

Purpose Despite systemic antibiotics and topical vancomycin powder, deep surgical-site infections (SSIs) remain a devastating complication of major posterior spine surgery, driving morbidity, costs, and antimicrobial resistance. In this study, we aimed to compare deep surgical-site infection (SSI) incidence following major posterior spine surgery between patients receiving intraoperative hypochlorous acid (HOCl) lavage and a historical control group receiving intrawound vancomycin powder. Methods In this retrospective comparative study, 161 patients undergoing major posterior spinal surgery received ≥2L of topical HOCl lavage, while 88 historical controls received intra-wound vancomycin powder. The primary endpoint was deep SSI incidence within 12 months. Demographics, operative variables, and microbiological data were analyzed with rigorous statistical methods. Results Deep SSI rates were nearly identical: 3.1% (5/161) with HOCl versus 3.4% (3/88) with vancomycin ( p = 0.999), with no HOCl-related adverse effects. Pathogen profiles (including MRSA, S. epidermidis, and E. coli) were comparable between groups, underscoring HOCl’s broad-spectrum efficacy. Conclusion HOCl lavage showed similar deep SSI rates to intrawound vancomycin powder in this retrospective cohort; prospective multicenter studies are warranted to validate these findings and define optimal protocols.