Comparison of preoperative hair removal methods for the reduction of surgical site infections: a meta-analysis

Aims and objectivesTo evaluate the efficacy of different methods of preoperative hair removal in reducing surgical site infections. BackgroundSurgical site infections are a major source of morbidity and prolonged hospitalisation following surgery. However, there is a lack of data regarding the impact of different preoperative hair removal techniques on the incidence of surgical site infections. DesignA systematic literature review and meta-analysis. MethodsRandomised controlled trials and controlled clinical trials reporting the impact of different methods of preoperative hair removal on reducing surgical site infections were collected through databases, including the Cochrane Library, Joanna Briggs Institute Library, PubMed, Elsevier, EMBASE, Nursing Consult, China Biology Medicine disc, China National Knowledge Infrastructure and Wanfang data. The articles were published from 1 January 1990-15 March 2016. Meta-analyses were conducted with review manager version 5.0. ResultsFourteen trials were included (16 comparisons) in the review, including 11 randomised controlled trials and three controlled clinical trials. Interventions in the studies were shaving, clipping, no hair removal and the use of depilatory cream. The meta-analyses included 7278 patients, from 10 countries. Nine studies compared shaving with no hair removal, four studies compared shaving with clipping, two studies compared shaving with depilatory cream, and one study compared clipping with no hair removal. No significant differences in the frequency of surgical site infections were observed between any of the methods assessed. ConclusionsNo significant differences between shaving, clipping, no hair removal and depilatory cream were observed in the frequency of surgical site infections. Relevance to clinical practicePreoperative hair removal should be avoided unless necessary. When it is necessary to remove hair, the existing evidence suggests that clipping is more effective in reducing surgical site infections than shaving or depilatory cream.