The clinical effectiveness of waxing or epilation compared with other methods of hair removal in reducing the incidence of surgical site infections: a protocol for a systematic review

Abstract

Background: Surgical site infections (SSIs) represent a significant challenge in healthcare, contributing to morbidity, mortality as well as economic burden. Traditional preoperative methods of hair removal are under scrutiny, with some methods potentiality increasing the risk of SSIs. This systematic literature review (SLR) protocol outlines the assessment of the clinical effectiveness of waxing and epilation compared with other methods of hair removal in reducing SSIs. Methods: Using PRISMA guidelines and the Joanna Briggs Institute Evidence Synthesis Checklist, this review aims to evaluate all interventional and observational studies that compare waxing or epilation against other methods or, indeed, no hair removal. The SLR has been prospectively registered with PROSPERO (ref: CRD42023423798). A comprehensive search strategy across Medline, Embase, CENTRAL, Clinicaltrials.Gov and CINAHL is planned, complemented by handsearching references of key articles. Important inclusion criteria include adult patient population, English language studies, and SSI reporting at 30 days. Both the Cochrane Risk of Bias (RoB2) tool and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool will be employed. Data extraction will include study characteristics, participant characteristics,intervention and comparator details, and primary outcome data. The primary outcome is overall incidence of SSIs and, if feasible, a quantitative analysis including meta-analysis will be performed. Discussion: This review has the potential to fill a knowledge gap around waxing and epilation as methods of preoperative hair removal, examining their impact on SSI incidence. These techniques offer theoretical advantages, such as extended hair-free periods and possible promotion of wound healing, but also have potential risks due to increased microtrauma. Due to the paucity of high-level evidence, there is a lack of consensus around their use. The outcomes of this review could reaffirm current guidelines or guide future practices. The high incidence of SSIs in areas like vascular surgery highlights the therapeutic potential of new evidence. One limitation of the study might be the small volume of literature on the subject, which could decrease statistical analysis power and make quantitative comparison challenging. If no high-quality evidence is found, this would indicate an unexplored area, potentially informing the design of primary research into waxing and epilation as SSI prevention methods. Conclusion: This protocol lays the foundation for a comprehensive review of the clinical effectiveness of waxing and epilation in the prevention of SSIs. The insights gained could shape current clinical practice, influence guidelines or guide future research, ultimately contributing to the reduction of the substantial burden of SSIs.