Clinical and cost comparison of three postoperative skin preparation protocols in CABG patients

This descriptive pilot study includes a clinical and cost comparison of three preoperative skin preparation protocols (razor, clipper, and depilatory cream, in combination with whole body disinfection) in 82 patients undergoing coronary artery bypass graft (CABG) surgery. The clinical research protocol included an evaluation of body surface area, index of body hair growth, depilatory effect, skin integrity after depilation, and side effects of body disinfection with chlorhexidine solution, as well as protocol-specific evaluation criteria. The cost comparison was performed by keeping a record of the materials used and the workload for each separate activity associated with the three preoperative skin preparation protocols. Material and labor costs were calculated for each of the different aspects of the protocols. Clinical evaluation revealed that the clipper protocol (if necessary, in combination with cream depilation) is most convenient for depilation of patients with heavy hair growth. The depilatory cream protocol is an appropriate method to depilate patients with slight or moderate hair growth. The razor method should be eliminated from clinical practice due to previous documented evidence of an associated increased risk of postoperative wound infection. Cost calculations revealed that the median hospital cost (standardized for differences in hair growth index, working hours and nurse qualification levels) of the razor, clipper, and cream protocols is $6.13, $9.84, and $8.16 (U.S. dollars), respectively. In 1995, yearly raw (i.e. non-standardized) hospital costs for the three procedures were $14,402, $16,114, and $16,765, respectively, with 708 CABG procedures performed. Although changing to a clipper and/or cream protocol may be associated with an initial, although moderate, increase in hospital costs, compared to the razor method, substantial cost savings could be expected long-term. The superiority of these protocols is primarily due to a decreased incidence of postoperative wound infections, as compared to that associated with the razor protocol.