Neurosurgery and shaving: what's the evidence?

Abstract

M ost patients undergoing neurosurgical proce dures dread the commonly performed preopera tive hair removal. Nevertheless, many neuro surgeons insist on removing the patient's hair before sur gery. They claim that this routine prevents postoperative infections and decreases the risk of overlooking wounds or lacerations after head trauma. Moreover, they argue that preoperative hair removal facilitates accurate plan ning of the incision, attachment and/or removal of the drapes, and closure of the wound.However, since the 1980s several reports have been published indicating that preoperative shaving may in crease the risk of postoperative infections due to a change or loss of protective skin flora and/or bacterial coloniza tion of the shaved area caused by the razor-induced mi crotrauma. 21,22,28 We systematically reviewed the current literature on preoperative shaving before neurosurgical procedures, and in this study we discuss the role of shaving preced ing craniotomies, bur hole procedures, spine surgery, and implantation surgery in both adults and children. Methods Literature Search StrategyTwo reviewers (M.L.D.B. and J.v.B.) searched Pub Med, Embase, and the Cochrane Database of Systematic Reviews up to September 8, 2009, using an electronic search strategy ([<neurosurgery> OR <neurosurgical pro cedures>] AND [<shaving> OR <hair removal>]) supple mented by hand searching the bibliographies of articles re trieved by the electronic search. We restricted this review to published data. Only papers written in English, Dutch, French, or German were considered for this review. Titles and abstracts of retrieved citations were screened, and po tentially suitable studies were read in full by both review ers. Relevant data were extracted and disagreements were resolved by discussion. The following inclusion criteria were used: 1) studies reporting on consecutive patient se ries in which either one predefined preoperative shaving policy was used or in which different policies were com pared; and 2) studies describing postoperative wound in fections and other serious (infectious) complications. Critical AppraisalThe authors aimed for a critical appraisal of the ar ticles guided by a simplified classification regarding level Department of Neurosurgery, Leiden University Medical Center, Leiden, The NetherlandsMany neurosurgeons remove their patients' hair before surgery. They claim that this practice reduces the chance of postoperative surgical site infections, and facilitates planning, attachment of the drapes, and closure. However, most patients dread this procedure. The authors performed the first systematic review on shaving before neurosurgical procedures to investigate whether this commonly performed procedure is based on evidence. They systematically re viewed the literature on wound infections following different shaving strategies. Data on the type of surgery, surgery related infections, preoperative shaving policy, decontamination protocols, and perioperative antibiotics protocols were collected. The search dete...

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“…Therefore, well‐designed and randomised‐controlled studies are needed to verify the effects of regional or strip hair removal on the development of SSI and on the body image of patients (Broekman et al . , Tanner et al . , Winston ).…”

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