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
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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.
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.
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.
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.
KeywordsEnhanced recovery after surgery (ERAS) Gynecology Gynecologic oncology Wound infections Surgical site infections Preoperative hair removal Shaving
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.
Compliance with ethical standards
Conflict of interest
No financial or personal conflict of interest by any of the authors to declare.
- 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.Google Scholar
- 7.Aimaq R, Akopian G, Kaufman HS (2011) Surgical site infection rates in laparoscopic versus open colorectal surgery. Am Surg 77(10):1290–1294Google Scholar
- 8.Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 10:CD001546.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):533–540Google Scholar
- 13.Hoe NY, Nambiar R (1985) Is preoperative shaving really necessary? Ann Acad Med Singapore 14(4):700–704Google 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):347–352Google Scholar
- 15.Kjønniksen I, Andersen BM, Søndenaa VG, Segadal L (2002) Preoperative hair removal--a systematic literature review. AORN J 75(5):928–938, 940.Google Scholar
- 16.Tanner J, Norrie P, Melen K (2011) Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev 11:CD004122Google Scholar
- 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.Google Scholar
- 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/
- 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.Google Scholar
- 25.Lazenby GB, Soper DE (2010) Prevention, diagnosis, and treatment of gynecologic surgical site infections. Obstet Gynecol Clin North Am 37(3):379–386Google Scholar
- 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.e9Google Scholar
- 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):100–106Google Scholar
- 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):779–786Google 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):245–253Google 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):193–200Google Scholar
- 33.Viney C, Cheater F (1992) Pre-operative shaving in gynaecology. Nurs Stand R Coll Nurs G B 1987 7(8):25–27Google Scholar
- 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):46–47Google Scholar
- 35.Jensen AT, Nielsen KR (1984) Preoperative chemical depilation. Results at a gynecological department. Ugeskr Laeger 146(11):813–815Google Scholar
- 36.Wyrzykiewicz T (1982) Shaving pubic hair before minor gynecological and obstetrical procedures—necessity or routine? Ginekol Pol 53(5–6):385–387Google 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):1074–1081Google Scholar