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Shoulder surgery preparation: a systematic review and meta-analysis.
Rajpal S Narulla1,2, Ryan Ting2, Stone Sima1,2
1Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, New South Wales, Australia.
JSES Reviews, Reports, and Techniques
|February 18, 2026
Summary
Benzoyl peroxide and pre-operative skin preparation solutions show the lowest culture positivity rates for shoulder surgery. Further research is needed to optimize perioperative shoulder preparation protocols.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Microbiology
Background:
- Shoulder surgical site infections are a significant complication.
- Prevention relies heavily on surgical preparation solutions.
- Effectiveness and usage of these solutions vary widely.
Purpose of the Study:
- To identify the most effective shoulder surgical site preparation methods.
- To review the literature on preventing surgical site infections in shoulder surgery.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Inclusion of human clinical studies on shoulder skin preparation.
- Searched English databases from 1980 to 2025 for relevant terms.
Main Results:
- Lowest culture positivity rates (27.1%) associated with benzoyl peroxide.
- Prior-to-day-of-surgery preparation (30.5%) also showed lower positivity.
- Non-alcohol solutions (24.8%) were more effective than alcohol-based ones (37.2%).
Conclusions:
- Current surgical preparation solutions have limitations in preventing day-of-surgery positivity.
- Even robust protocols result in high culture positivity rates.
- Further trials are necessary to standardize perioperative shoulder preparation.
