Patient satisfaction and outcomes following shave-free craniotomy

Background: Hair shaving during craniotomy is traditionally performed to facilitate skin preparation and improve intraoperative visibility, but it may cause cosmetic and psychological concerns for patients. Evidence supporting its role in reducing postoperative infections is limited. In this study, we evaluated patient satisfaction with a shave-free craniotomy technique and examined postoperative infection rates. Methods: We retrospectively reviewed patients who underwent shave-free craniotomy performed by the author between April 2018 and April 2023. Procedures that did not require shaving, as well as surgeries in which additional or extended incisions were anticipated, were excluded. Eligible patients were mailed a questionnaire between July and October 2023. The survey assessed (1) preoperative anxiety related to shaving, (2) expectations regarding shaving before preoperative explanations, and (3) satisfaction with the shave-free procedure (0–100 scale). Postoperative wound infections were also assessed. Results: A total of 116 surgeries were performed on 115 patients. Fifty-five patients (48%) responded to the questionnaire. Shaving-related anxiety accounted for 10.7% of overall preoperative anxiety. Before receiving preoperative explanations, 18% of patients expected total shaving, 80% expected partial shaving, and 1.8% expected no shaving. Satisfaction scores were high for both women (95.8 ± 16.9) and men (96.7 ± 5.7). Two postoperative wound infections (1.7%) were observed, one of which required bone flap removal. Conclusion: Shave-free craniotomies were associated with high patient satisfaction and did not increase the risk of postoperative infections. Although cosmetic concerns differ among individuals, avoiding hair removal may help reduce anxiety in some patients without compromising surgical safety.