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Current practice and physicians’ opinion about preoperative hair removal as a part of ERAS pathway implementation in gynecology and gynecology–oncology: a NOGGO-AGO survey of 148 gynecological departments in Germany

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To gather standardized information about current practices and doctors’ opinions on preoperative hair removal (PHR) from the surgical site and to evaluate the extent of PHR as one of the elements of enhanced recovery after surgery (ERAS) pathways that is established in the clinical routine in gynecology and gynecology–oncology departments in Germany.

Methods

We performed a nationwide survey among 638 primary, secondary and tertiary health care gynecological departments in Germany. Data were obtained by sending a multiple-choice questionnaire about preoperative management of hair removal. The authors also evaluated the awareness of doctors regarding PHR as well as the method and time frames of PHR. The results were compared to the existing standard of procedure (SOP) and guidelines.

Results

148 units (23.2%) took part in the survey; participants in the survey were mostly chief physicians in 47.3% of the cases. Half (50.7%) of all the responses came from certified gynecological cancer centers. A SOP regarding PHR was reported as present in 113 clinics (76.4%). 83.8% of all units are performing PHR for midline laparotomy, 52.7% in laparoscopic operations, and 45.3% in vaginal operations. 48% used a clipper, while 43.2% utilized a single-use razor. 56.1% shaved instantly before the operation, whereas 35.8% did it the day before and earlier. 40.3% of chief physicians believe that PHR causes more surgical site infections (SSI) compared to only 11.5% of junior doctors.

Conclusion

PHR in gynecological departments in Germany is performed very heterogeneously and SOPs are often not based on guidelines and ERAS principles. Around one-third of the German gynecological clinics keep strictly to the guidelines. The awareness on PHR and SSI among junior doctors is very low.

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References

  1. Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 248(2):189–198

    Article  PubMed  Google Scholar 

  2. Ansari D, Gianotti L, Schröder J, Andersson R (2013) Fast-track surgery: procedure-specific aspects and future direction. Langenbecks Arch Surg. Januar 398(1):29–37

    Article  Google Scholar 

  3. Zhuang C-L, Ye X-Z, Zhang X-D, Chen B-C, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56(5):667–678

    Article  PubMed  Google Scholar 

  4. Muallem MZ, Dimitrova D, Pietzner K, Richter R, Feldheiser A, Scharfe I (2016) Implementation of enhanced recovery after surgery (ERAS) pathways in gynecologic oncology. A NOGGO-AGO* survey of 144 Gynecological Departments in Germany. Anticancer Res 36(8):4227–4232.

  5. Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78(5):606–617

    Article  CAS  Google Scholar 

  6. Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183(6):630–641

    Article  Google Scholar 

  7. Aimaq R, Akopian G, Kaufman HS (2011) Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg 77(10):1290–1294

    PubMed  Google Scholar 

  8. Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 10:CD001546.

  9. Mangano DT (2004) Perioperative medicine: NHLBI working group deliberations and recommendations. J Cardiothorac Vasc Anesth 18(1):1–6

    Article  PubMed  Google Scholar 

  10. World Health Organization. Global guidelines for the prevention of surgical site infection. 2016. https://apps.who.int/iris/bitstream/10665/250680/1/9789241549882-eng.pdf?ua=1

  11. Ott E, Saathoff S, Graf K, Schwab F, Chaberny IF (2013) The prevalence of nosocomial and community acquired infections in a university hospital: an observational study. Dtsch Arzteblatt Int 110(31–32):533–540

    Google Scholar 

  12. Poirot K, Le Roy B, Badrikian L, Slim K (2018) Skin preparation for abdominal surgery. J Visc Surg 155(3):211–217

    Article  CAS  PubMed  Google Scholar 

  13. Hoe NY, Nambiar R (1985) Is preoperative shaving really necessary? Ann Acad Med Singapore 14(4):700–704

    CAS  PubMed  Google Scholar 

  14. Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MJ (1983) The influence of hair-removal methods on wound infections. Arch Surg Chic Ill 1960. 118(3):347–352

  15. Kjønniksen I, Andersen BM, Søndenaa VG, Segadal L (2002) Preoperative hair removal--a systematic literature review. AORN J 75(5):928–938, 940.

  16. Tanner J, Norrie P, Melen K (2011) Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev 11:CD004122

  17. Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L (2014) Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(6):605–627.

  18. Preventing surgical site infections. Key recommendations for practice. Dublin: Joint Royal College of Surgeons in Ireland/Royal Colleges of Physicians of Ireland Working Group on Prevention of Surgical Site Infection; 2012. https://www.rcsi.ie/files/surgery/docs/20140318021114_Sample%20Audit%20Surgical%20site%20Inf.pdf. Accessed 21 July 2016

  19. Targeted literature review (2015) What are the key infection prevention and control recommendations to inform a surgical site infection (SSI) prevention quality improvement tool? Version 3.0. February 2015. Edinburgh: Health Protection Scotland. https://www.documents.hps.scot.nhs.uk/hai/infection-control/evidence-for-carebundles/literature-reviews/ssi-review-2015-02.pdf. Accessed 21 July 2016

  20. Online-Plattform ‚Guidelines Schweiz‘ [Internet]. [zitiert September 2018]. Verfügbar unter: https://www.guidelines.fmh.ch/

  21. Chaberny IF, Graf K (2011) Strategien zur Prävention von postoperativen Wundinfektionen. Unfallchirurg 114(3):236–240

    Article  CAS  PubMed  Google Scholar 

  22. Deutsche Gesellschaft für Krankenhaushygiene e.V. [Internet]. [zitiert 20. September 2018]. Verfügbar unter. https://www.krankenhaushygiene.de/informationen/hygiene-tipp/hygienetipp2009/171

  23. High impact intervention (2011) Care bundle to prevent surgical site infection. London: Department of Health. https://webarchive.nationalarchives.gov.uk/20120118164404/https://hcai.dh.gov.uk/files/2011/03/2011-03-14-HII-Prevent-Surgical-Siteinfection-FINAL.pdf. Accessed 21 July 2016

  24. ACOG Committee on Practice Bulletins-Gynecology (2009) ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 113(5):1180–1189.

  25. Lazenby GB, Soper DE (2010) Prevention, diagnosis, and treatment of gynecologic surgical site infections. Obstet Gynecol Clin North Am 37(3):379–386

  26. Lake AG, McPencow AM, Dick-Biascoechea MA, Martin DK, Erekson EA (2013). Surgical site infection after hysterectomy. Am J Obstet Gynecol 209(5):490.e1–490.e9

  27. Bakkum-Gamez JN, Dowdy SC, Borah BJ, Haas LR, Mariani A, Martin JR (2013) Predictors and costs of surgical site infections in patients with endometrial cancer. Gynecol Oncol 130(1):100–106

  28. Mahdi H, Gojayev A, Buechel M, Knight J, SanMarco J, Lockhart D (2014) Surgical site infection in women undergoing surgery for gynecologic cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 24(4):779–786

  29. Gerestein CG, Damhuis RAM, Burger CW, Kooi GS (2009) Postoperative mortality after primary cytoreductive surgery for advanced stage epithelial ovarian cancer: a systematic review. Gynecol Oncol 114(3):523–527

    Article  PubMed  Google Scholar 

  30. Matsuo K, Prather CP, Ahn EH, Eno ML, Tierney KE, Yessaian AA (2012) Significance of perioperative infection in survival of patients with ovarian cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 22(2):245–253

  31. Saeed MJ, Dubberke ER, Fraser VJ, Olsen MA (2015) Procedure-specific surgical site infection incidence varies widely within certain National Healthcare Safety Network surgery groups. Am J Infect Control 43(6):617–623

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wick EC, Hobson DB, Bennett JL, Demski R, Maragakis L, Gearhart SL (2012) Implementation of a surgical comprehensive unit-based safety program to reduce surgical site infections. J Am Coll Surg 215(2):193–200

  33. Viney C, Cheater F (1992) Pre-operative shaving in gynaecology. Nurs Stand R Coll Nurs G B 1987 7(8):25–27

  34. Lui PS, Ching KC, Salmon YM, Choo HT, Yeo GC, Sng EH (1984) Post-operative wound infection following gynaecological operations. Singapore Med J 25(1):46–47

    CAS  PubMed  Google Scholar 

  35. Jensen AT, Nielsen KR (1984) Preoperative chemical depilation. Results at a gynecological department. Ugeskr Laeger 146(11):813–815

  36. Wyrzykiewicz T (1982) Shaving pubic hair before minor gynecological and obstetrical procedures—necessity or routine? Ginekol Pol 53(5–6):385–387

    CAS  PubMed  Google Scholar 

  37. Badia JM, Casey AL, Rubio-Pérez I, Crosby C, Arroyo-García N, Balibrea JM (2018) A survey to identify the breach between evidence and practice in the prevention of surgical infection: time to take action. Int J Surg Lond Engl 54(Pt A):290–297

    Article  Google Scholar 

  38. Ng W, Alexander D, Kerr B, Ho MF, Amato M, Katz K (2013) A hairy tale: successful patient education strategies to reduce prehospital hair removal by patients undergoing elective caesarean section. J Hosp Infect 83(1):64–67

    Article  CAS  PubMed  Google Scholar 

  39. Kamei J, Yazawa S, Yamamoto S, Kaburaki N, Takahashi S, Takeyama M (2018) Risk factors for surgical site infection after transvaginal mesh placement in a nationwide Japanese cohort. Neurourol Urodyn 37(3):1074–1081

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Authors and Affiliations

  1. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany

    Helmut Plett, Enzo Ricciardi, Mareike Bommert & Alexander Traut

  2. Department of Gynecology and Obstetrics, Mathias-Spital Rheine, Frankenburgstr. 31, 48431, Rheine, Germany

    Hendrik Veldink

  3. Young Academy of Gynecologic Oncology (JAGO) of the NOGGO, Berlin, Germany

    Mareike Bommert & Hendrik Veldink

  4. Department of Gynecology with Center for Oncological Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany

    Helmut Plett, Klaus Pietzner, Mustafa Zelal Muallem & Jalid Sehouli

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  1. Helmut Plett
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  2. Enzo Ricciardi
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Contributions

HP and JS conceived the presented idea, developed the theory and performed the computations. AT verified the analytical methods. MB and HV encouraged HP to investigate “SurveyMonkey” as an online tool and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript. HP carried out the project. HP wrote the manuscript with support from ER, MB and HV. JS supervised the project. KP helped supervise the project. AT developed the theoretical formalism, performed the analytic calculations and performed the numerical simulations. All authors provided critical feedback and helped shape the research, analysis and manuscript. HP, MB and HV designed the model and the computational framework and analyzed the data. AT performed the calculations.

Corresponding author

Correspondence to Helmut Plett.

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NOGGO-AGO, Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie-Arbeitsgemeinschaft Gynäkologische Onkologie (North-Eastern-German Society of Gynaecological Oncology- Society of Gynecological Oncology).

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Plett, H., Ricciardi, E., Bommert, M. et al. Current practice and physicians’ opinion about preoperative hair removal as a part of ERAS pathway implementation in gynecology and gynecology–oncology: a NOGGO-AGO survey of 148 gynecological departments in Germany. Arch Gynecol Obstet 299, 1607–1618 (2019). https://doi.org/10.1007/s00404-019-05132-w

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