Clinical Outcomes of Preoperative Hair Clipping versus No Clipping in Cranial Neurosurgery: A Systematic Review and Meta-Analysis.

Abstract

This meta-analysis aimed to assess the clinical impact of preoperative hair clipping versus no clipping in cranial neurosurgery, addressing an important element of patient-centered care that balances surgical needs with patient comfort. By examining existing evidence, this study seeks to inform neurosurgical practices on preoperative preparation choices that respect both clinical safety and patient preferences. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews, articles from PubMed, Google Scholar, Embase, Scopus, and ScienceDirect, and studies that included adult patients undergoing cranial surgeries were included for data extraction and analysis. Studies were selected based on the presence of preoperative hair clipping or no clipping as a variable. Only comparative studies evaluating clipping versus no clipping were included, and razor-only or noncomparative hair-removal studies were excluded. The primary outcomes compared between these groups included infection rates, reoperation rates, readmission rates, and postoperative complications. Where available, details of perioperative protocols (preoperative Hibiclens/chlorhexidine showers, intraoperative scalp prep, postoperative antibiotic regimens, wound coverage, and timing of hair washing) were extracted. The analysis of studies (n = 22) revealed a higher infection rate in the clipping group compared to the no-clipped group (3% vs. 2%; 95% confidence interval [CI] 2-5% vs. 1-3%), though this difference was not statistically significant (P = 0.10). Reoperation rates were slightly higher in the no-clipping group than the clipping group (1% vs. 0%; 95% CI 0-3% vs. 0-1%), but this difference was also not statistically significant (P = 0.35). No significant difference in readmission rates was observed between the 2 groups (0% vs. 0%; 95% CI 0-3% vs. 0-1%, P = 0.83). Postoperative complications, primarily wound dehiscence, were comparable between the clipping and no-clipping groups (1% vs. 1%; 95% CI 0-2% vs. 0-3%, P = 0.61). This meta-analysis found no statistically significant differences in infection, reoperation, readmission rates, or postoperative complications between patients undergoing cranial neurosurgery with or without hair clipping. These findings suggest that preoperative hair clipping may not be clinically necessary, allowing patient preference to be incorporated without compromising outcomes. Furthermore, variations in perioperative antiseptic, antibiotic, and wound-care practices highlight the need for standardized reporting in future studies.