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To wrap or not to wrap: A retrospective review of circumcision dressing and post-procedural bleeding
Benjamin T Many1, Beshoy Benyamen1, Camille M Moeckel1
1Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Department Of Surgery, Chicago, IL, USA.
Insights
Circumcision bleeding complications were studied. Circumferential wrap dressings significantly reduced postoperative bleeding events compared to ointment alone in boys undergoing circumcision.
Area of Science:
- Pediatric surgery
- Urology
- Surgical complications
Background:
- Post-circumcision bleeding is a significant complication.
- Comparing management strategies for bleeding is crucial.
Purpose of the Study:
- To compare postoperative bleeding after circumcision using circumferential wrap dressings versus ointment alone.
- To identify risk factors for bleeding complications.
Main Methods:
- Retrospective review of boys (≤18 years) undergoing circumcision (2017-2018).
- Analysis of bleeding events defined by clinical visits or reoperation.
- Comparison of outcomes between wrap dressing and ointment groups using univariate and multivariable modeling.
Main Results:
- Of 681 boys, 503 received wrap dressings and 178 received ointment.
- Bleeding events occurred in 2.7% with wraps vs. 7.8% with ointment (p < 0.01).
- Wrap dressing remained significantly associated with decreased bleeding (OR=2.81, p < 0.01) after controlling for other factors.
Conclusions:
- Circumferential wrap dressings are associated with a significant decrease in postoperative bleeding after circumcision.
- This finding supports the use of wrap dressings to minimize bleeding complications.
Introduction:
Bleeding is an infrequent, but important, complication after circumcision. Our aim was to examine postoperative bleeding events after circumcision comparing patients managed with a circumferential wrap to ointment alone.
Methods:
Boys ≤18 years of age who underwent circumcision at a tertiary children's hospital were retrospectively reviewed between 2017 and 2018. Postoperative bleeding was defined by phone calls, clinic or Emergency Department visits, or return to the operating room. Outcomes were examined by univariate association and multivariable modeling.
Results:
Of 681 boys undergoing circumcision, 503 (74%) patients received a wrap dressing and 178 (26%) only ointment. There were 28 (4%) patients who had a postoperative bleeding event: 14/503 (2.7%) among wrap dressings and 14/178 (7.8%) among ointment alone (p < 0.01). The majority of events were phone calls related to bleeding (75%). Univariate analysis demonstrated no association between postoperative bleeding and surgeon specialty (p = 0.72), age at circumcision (p = 0.44) or technique type (p = 0.09). After controlling for age, technique type, and surgeon specialty, dressing type remained significantly associated with postoperative bleeding (OR = 2.81, p < 0.01).
Conclusion:
This single-center, retrospective review found circumferential wrap dressings are associated with a decrease in bleeding events after circumcision.
Level Of Evidence:
III - retrospective case-control study.
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