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A contemporary snapshot of circumcision in US children's hospitals
Benjamin T Many1, Yazan K Rizeq2, Jonathan Vacek1
1Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago; Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine.
Insights
Neonatal circumcision rates increased significantly in US children's hospitals since 2012. Perinatal specialists now perform more circumcisions, indicating a trend toward earlier, more cost-effective procedures.
Area of Science:
- Pediatric Surgery
- Public Health Trends
- Healthcare Economics
Background:
- The American Academy of Pediatrics (AAP) affirmed the health benefits of neonatal circumcision outweighing risks in 2012.
- This study examines recent trends in male circumcision procedures within US freestanding children's hospitals.
Purpose of the Study:
- To analyze trends in male circumcision rates across different age groups in children's hospitals.
- To investigate changes in the specialties performing circumcisions.
- To assess the economic implications of circumcision timing.
Main Methods:
- Retrospective, cross-sectional analysis of the Pediatric Health Information System (PHIS) database.
- Inclusion of male patients under 18 years old who underwent circumcision as a sole procedure between 2010 and 2017.
- Data collection on age at procedure, costs, and performing specialty.
Main Results:
- Out of 171,680 circumcisions, neonatal procedures increased from 39% to 58% (p < 0.001) between 2010 and 2017.
- The proportion of infant circumcisions decreased over the study period.
- Average annual system cost was $32 million USD, with a median cost of $2892 per ambulatory circumcision. Obstetricians and Pediatricians performed a growing share of these procedures.
Conclusions:
- A notable increase in neonatal circumcisions has occurred in US children's hospitals since 2012.
- Perinatal specialties are increasingly performing circumcisions, suggesting a shift towards earlier intervention.
- Circumcision during the birth hospitalization is more resource-effective than later procedures.
Background:
In 2012, the American Academy of Pediatrics (AAP) concluded the health benefits of circumcision during the neonatal period outweigh the risks. This study describes recent trends in male circumcision in freestanding children's hospitals in the United States.
Methods:
Using the Pediatric Health Information System (PHIS), male patients <18 years of age who were circumcised without any additional procedures between the years 2010 and 2017 were identified. Data included age at procedure (neonate: 0-30 days, infant: 31-365 days, early childhood: ≥1 to <5 years, and older child: ≥5 to<18 years), cost, and specialty performing the circumcision.
Results:
Of the 171,680 circumcisions performed, 85,270 (50%) were during neonatal period, 29,060 (17%) during infancy, 30,276 (18%) early childhood, and 26,355 (16%) thereafter. Circumcision in neonates increased from 39% to 58% (p < 0.001), and the proportion performed during infancy decreased over time. System level cost for ambulatory circumcision averaged $32 million USD annually, and median cost per ambulatory circumcision was $2892 USD. Obstetricians and Pediatricians are performing proportionally more circumcisions.
Conclusion:
Since 2012, proportionally more neonates are undergoing circumcision in US children's hospitals. Perinatal specialties are performing an increasing proportion of circumcisions. Circumcision during the birth hospitalization in the neonatal period is more resource-effective than postponing until later in infancy.
Type Of Study:
Retrospective, cross-sectional analysis.
Level Of Evidence:
Level IV.
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