Red for danger: the effects of red hair in surgical practice

Traditionally, surgeons and anaesthetists regard red haired patients with some trepidation because of their reputation for excessive bleeding, a reduced pain threshold, and an, albeit anecdotal, increased tendency to develop hernias.

An estimated 1% to 2% of the general population worldwide has the phenotype for red hair, increasing to between 2% and 6% in the northern hemisphere.1 The typical phenotype associated with red hair is fair skin, freckles, and light coloured eyes. This colouration results from high levels of the red pigment phaeomelanin and reduced levels of the dark pigment eumelanin. Red haired people are also sensitive to ultraviolet light.2 Despite several validated methods to stratify surgical risk and outcome on the intensive care unit, such as the American Society of Anaesthesiology score3 and the acute physiological and chronic health evaluation score,4 none take into account the effect of red hair. We discuss the magnitude of risk posed to clinicians by patients with red hair.