Neurosurgery and shaving: what's the evidence?

Area of Science:

• Neurosurgery
• Infectious Disease Epidemiology
• Evidence-Based Medicine

Background:

• Preoperative hair removal is a common practice in neurosurgery.
• The rationale includes reducing surgical site infections and aiding surgical procedures.
• Patient anxiety regarding hair removal is significant.

Purpose of the Study:

• To systematically review the evidence for preoperative hair removal in neurosurgery.
• To determine if shaving patients before neurosurgical procedures reduces infection rates.
• To assess the scientific basis for current neurosurgical hair removal practices.

Main Methods:

• Systematic literature review of studies on wound infections and shaving strategies.
• Inclusion of 21 studies (11,071 patients) from 165 initially identified articles.
• Analysis of data on surgery type, infections, shaving policies, and antibiotic protocols.

Main Results:

• No studies provided evidence that preoperative shaving decreases postoperative wound infections.
• Review included data on craniotomies, implantation surgery, bur hole procedures, and spine surgery.
• Nine studies specifically addressed pediatric neurosurgical shaving policies.

Conclusions:

• There is no evidence to support the routine practice of preoperative hair removal in neurosurgery.
• Current recommendations for preoperative shaving lack a strong scientific foundation.
• Further well-designed studies are required to establish evidence-based guidelines for hair removal.