Effectiveness of preoperative shaving and postoperative shampooing on the infection rate in neurosurgery patients: A meta-analysis

Abstract

Objective: To evaluate the effectiveness of preoperative shaving and postoperative shampooing on the infection rate in neurosurgery.

Design: Meta-analysis.

Data source: We conducted a search of the Embase, CINAHL, Scopus and PubMed databases up until February 1, 2022. Comparative studies were included. No language restrictions were applied.

Review methods: Original articles that compared the infection rate of patients who had their hair shaved before neurosurgery to the infection rate of unshaven patients were included. Original articles comparing the infection rates of patients whose hair was early postoperative shampooing versus patients whose hair was not shampooed after neurosurgery were also included. The risk of bias was also evaluated using the Newcastle-Ottawa quality assessment scale by two authors independently. The meta-analyses were performed using Review Manager software (RevMan 5.3; Cochrane Collaboration). The odds ratios (ORs) and 95% confidence intervals (CIs) were assessed for dichotomous data (infection rate). The heterogeneity of the included studies was assessed using the I² statistic (ranging from 0 to 100%).

Results: A total of 3451 studies were identified by searching the PubMed, Scopus, CINAHL and Embase databases. Fourteen studies met the inclusion criteria, however two studies did not provide data suitable for meta-analysis. Twelve studies were included in the review. Two historical control studies, four prospective studies, one clinical trial and five retrospective studies were identified. There were 4583 patients whose hair was not shaved and 4295 patients whose hair was shaved. Among them, there were 3874 patients whose hair was unshaved and was early postoperative shampooing. No significant difference in the infection rate was found between the unshaved group and shaved group (OR: 0.86, 95% CI [0.62, 1.19], P = 0.85, I² = 0%). A significant difference in the infection rates in shunt surgery patients was found between the unshaved group and shaved group (OR: 0.43, 95% CI [0.19, 0.99], P = 0.89, I² = 0%). No significant difference was found between the unshaved with early shampooing group and the shaved group (OR: 0.82, 95% CI [0.48, 1.41], P = 0.80, I² = 0%).

Conclusion: Hair preservation before neurosurgery and early shampooing after neurosurgery did not increase the infection rate.

Keywords: Cranial; Hair; Hair preservation; Hair removal; Neurosurgery; Shampoo; Surgical site infection.