COMMENTARY

Should Hair Be Removed Before Surgery?

Albert B. Lowenfels, MD

Disclosures

December 22, 2016

Impact of Hair Removal on Surgical Site Infection Rates: A Prospective Randomized Noninferiority Trial

Kowalski TJ, Kothari SN, Mathiason MA, Borgert AJ
J Am Coll Surg. 2016;223:704-711

Summary

The aim of this study was to examine the impact of hair removal on infection rates for surgical-site wounds. Patient were randomly assigned to group that underwent hair removal by clippers (n = 834) or a group with no hair removal (n = 844). More than 90% of the patients in both groups were men, and about two thirds of the operations were herniorrhaphies.

Wound infections occurred in 47 patients (6.12%) in the clipped group and in 49 patients (6.32%) in the nonclipped group. Because these wound infection rates were nearly identical—only 0.20% difference—the authors concluded that wound infection rates were similar regardless of whether hair had been removed from the surgical site.

Viewpoint

Throughout most of the 20th century, hair removal, usually by shaving with a razor, was accepted as part of the patient's preoperative preparation. However, in 1999, the Centers for Disease Control and Prevention (CDC) guidelines for avoiding surgical-site wound infections did not recommend hair removal.[1] The topic remains especially controversial because many of the reports are based on small numbers of patients, and because the results may be confounded by other efforts to control wound infections.

One unexplained finding in this report is the relatively high frequency of wound infections either with or without hair removal (6%), rather than the rate anticipated by the authors (around 2%). This report, although based on a large number of patients, failed to confirm the CDC's recommendations against hair removal before surgery.

Abstract

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