Postoperative surgical site infection after preoperative use of razor versus clipper for hair removal in inguinal hernia surgery: A quasi-randomized clinical trial

Niranjan Thapa; Sunil Basukala; Shiva K Regmi; Oshan Shrestha; Sandip Paudel; Kabita Chaudhary; Bipin Metha; Manoj K C; Suman Thapa; Sachhyatkar Bista

doi:10.1002/hsr2.1830

Postoperative surgical site infection after preoperative use of razor versus clipper for hair removal in inguinal hernia surgery: A quasi-randomized clinical trial

Health Sci Rep. 2024 Jan 24;7(1):e1830. doi: 10.1002/hsr2.1830. eCollection 2024 Jan.

Authors

Affiliations

¹ Department of Surgery College of Medicine, Nepalese Army Institute of Health Sciences Kathmandu Nepal.
² Department of Surgery Nepalese Army Institute of Health Sciences Kathmandu Nepal.
³ Department of Anaesthesia Nepalese Army Institute of Health Sciences Kathmandu Nepal.

Abstract

Trail design: Quasi-randomized clinical trial.

Methods: Participants: This study includes adult patients (≥18 years) who gave written consent for preoperative site preparation using razors or clippers. Exclusions comprised individuals <18 years, bilateral hernias, prior laparoscopic hernia repair, steroid/chemotherapy use, diagnosed chronic obstructive pulmonary disease, and incomplete medical documentation. Intervention: Patients who underwent hernia surgery during the initial week of the study underwent site preparation using a razor, while in subsequent weeks underwent site preparation using a clipper. This randomization was maintained throughout the study. Uniform site preparation was done by consistent staff. Postpreparation interviews, follow-up interviews of the patients, and unbiased evaluation of digital photographs were conducted by nonoperating surgeon panels. Outcome: Preoperative, patient response, degree of skin trauma, quality of hair removal, and association between site preparation-like parameters were compared and analyzed between two groups using Statistical Package for Social Sciences-25. Blinding: In this study, blinding was not done and the primary investigator was aware of the two groups.

Results: The total number of participants was 320. The mean age of the Razor group was 45.36 ± 14.68 years and that of Clipper was 44.42 ± 13.77 (p < 0.98). The incidence of surgical site infection (SSI) was 23 (14.4%) in the razor group and 8(5%) in the clipper group, (p = 0.01). Skin trauma was found more in the razor group as compared to the clipper group. Also, the analysis of the provided data revealed that 65% of participants who experienced sustained cuts developed SSI.

Conclusion: In summary, the practice of preoperative hair removal on-site preparation using a razor is associated with the incidence of skin trauma but overall shave quality at the operative site was better in the razor group with an apparent increased risk of SSI. Based on these findings, it would be better for surgeons to decide on an operation for either razors or clippers for preoperative preparation.

Keywords: clipper; hernia surgery; razor; surgical site infection.