The safety and effectiveness of hypochlorous acid used as surgical irrigation solution to reduce postoperative...

The safety and effectiveness of hypochlorous acid used as surgical irrigation solution to reduce postoperative complications: A systematic review and network meta-analysis (NMA).

The objective of this systematic literature review was to determine the safety and effectiveness of hypochlorous acid (HOCl) surgical irrigation solution compared to alternative treatments.

PubMed and EMBASE databases were searched between 2009 and 2024. Quantitative synthesis technology was utilized for summary statistics and NMA. Meta-analytical regression analyses were performed using R, with 2-sided P values < .05 considered statistically significant.

Eighty-one studies, 13 of which reported HOCl as the primary intervention, were included for the final NMA, and 46 studies for subgroup analysis in abdominal surgery. Surgical site infection (SSI) was reported, and the NMA showed that the odds of SSI were nearly twice as likely (OR 1.97, (95% CI [1.13, 3.44]) for basic irrigation than that of HOCl. A pairwise, study-level, meta-analytical regression of abdominal subgroup studies, directly comparing HOCl irrigation with other agents, demonstrated a statistically significant reduction (P= .010) in SSI risk. Across eleven contrasts, HOCl reduced odds of SSI approximately 50% relative to basic irrigation.

These findings indicate that HOCl irrigation provides a safe, statistically and clinically meaningful reduction in SSI risk compared with basic irrigation. Additional studies are warranted as the magnitude of benefit may vary by intervention type and surgical context.