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.

PurposeDespite 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.MethodsIn 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.ResultsDeep 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.ConclusionHOCl 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.