Caregiver Reported Reasons for Delay of Neonatal Circumcision

Area of Science:

• Pediatrics
• Urology
• Public Health

Background:

• Neonatal circumcision is a common procedure with established benefits.
• Caregiver decisions and healthcare system factors can influence the timing of elective circumcisions.
• Delayed circumcision may necessitate more complex procedures, including general anesthesia.

Purpose of the Study:

• To identify caregiver-reported reasons for delaying desired neonatal circumcisions.
• To explore factors contributing to circumcision delays in infants and young children.
• To assess the impact of delayed circumcision on subsequent anesthesia requirements.

Main Methods:

• A survey was administered to caregivers requesting elective outpatient circumcision at two urban tertiary care hospitals between January 2017 and December 2018.
• Data collected included patient/parent demographics, insurance status, comorbidities, birth history, and reasons for circumcision desire and delay.
• Exclusion criteria included boys over 3 years of age and those with abnormal penile anatomy.

Main Results:

• Surveys from 206 caregivers (90% response rate) indicated common reasons for delay included the birth physician/hospital not performing neonatal circumcision (26%) and prematurity (16%).
• Publicly-insured boys were more likely to experience delays related to birth hospital practices (P=.02).
• Over 35% of full-term boys without comorbidities, initially eligible for circumcision without general anesthesia, ultimately required it due to delay.

Conclusions:

• Delayed circumcision is frequently associated with birth hospital practices and prematurity, particularly among publicly-insured and African-American populations.
• A significant proportion of boys requiring general anesthesia for circumcision could have avoided it if the procedure was performed at birth.
• Early circumcision at birth is recommended to avoid potential complications and the need for general anesthesia in later infancy.