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Caregiver Reported Reasons for Delay of Neonatal Circumcision
Deborah L Jacobson1, Anthony D'Oro1, Fizan Abdullah2
1Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL.
Insights
Delaying neonatal circumcision, often due to birth hospital practices or prematurity, can lead to increased need for general anesthesia. Performing circumcision at birth could prevent over 35% of these cases.
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.
Objectives:
To determine caregiver-reported reasons for delay of desired neonatal circumcision.
Methods:
Caregivers requesting elective outpatient circumcision at two urban tertiary care hospitals were surveyed from 1/2017 to 12/2018. Boys >3 years and those with abnormal penile anatomy were excluded. Patient/parent demographics, insurance status, comorbidities, birth history, family history, reasons circumcision was desired, and reasons for circumcision delay were obtained.
Results:
Surveys were completed by 206/229 caregivers (90% response rate). Respondents were primarily mothers (74%) who identified as African-American (62%). Eligible boys presented at a median 7.5 months [0.3-35.6] and were predominantly African-American (63%), publicly-insured at birth (83%), and publicly-insured at present (86%). 80% were full-term. 83% had no comorbidities. Most caregivers (84%) requested inpatient circumcision, primarily for penile cleanliness (75%) and infection prevention (72%). Common reasons for delay included neonatal circumcision not being performed by the birth physician/hospital (26%) and prematurity (16%). Publicly-insured boys were more likely to encounter delays related birth physician/hospital not performing circumcisions (P = .02). Non-Caucasian/mixed race boys were less likely to be eligible for circumcision without general anesthesia (P = .004). In 108 cases (52%), circumcision was requested for full-term boys without comorbidities. Of these, 72 (35% of the cohort) now require general anesthesia to undergo circumcision.
Conclusion:
Among 206 boys experiencing circumcision delay, most were full-term, African-American, and publicly-insured. Common reasons for delay included neonatal circumcision not being performed by the birth hospital/physician and prematurity. General anesthesia could have been avoided in >35% of boys if circumcision was performed at birth.
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