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Neonatal circumcision: associated factors and length of hospital stay
C J Mansfield1, W J Hueston, M Rudy
1Department of Family Medicine, East Carolina University School of Medicine, Greenville, North Carolina, USA.
Insights
Routine infant circumcision is associated with race, insurance, and delivery interventions. Circumcised infants had longer hospital stays, potentially costing millions annually.
Area of Science:
- Neonatal care
- Pediatric surgery
- Public health
Background:
- Routine neonatal circumcision efficacy remains debated.
- Limited data exists on factors influencing circumcision decisions and resource utilization.
Purpose of the Study:
- To investigate associations between neonatal circumcision and parental/provider characteristics.
- To examine medical resource use, specifically hospital length of stay, related to circumcision.
Main Methods:
- Analysis of 3703 healthy male infants born in 1990-1991 across four US sites.
- Logistic regression models used to identify factors associated with circumcision.
Main Results:
- 85% of infants were circumcised; higher rates observed in White and African-American infants.
- Infants with private insurance, and those whose mothers had episiotomies or cesarean sections, showed increased circumcision odds.
- Circumcised infants had a 0.26-day longer average hospital stay.
Conclusions:
- Neonatal circumcision rates are linked to maternal race, insurance status, and delivery interventions.
- Interventional delivery methods may reflect parental or physician preferences.
- Extended hospital stays for circumcised infants represent a significant national healthcare cost.
Background:
Controversy exists regarding the efficacy of routine neonatal circumcision of male infants. Little is known about parental or provider characteristics or the use of medical resources associated with this procedure.
Methods:
Records of 3703 male infants born during 1990 and 1991 at four US sites were analyzed to discern associations between circumcision and the above factors. Analyses were limited to healthy infants.
Results:
Eighty-five percent of the infants in the study population were circumcised. White and African-American male infants were much more likely to be circumcised than those of other races (odds ratios [ORs], 7.3 and 7.1, respectively, P < .001). Compared with self-pay patients, those covered by private insurance were 2.5 times more likely to be circumcised (P < .001). Logistic regression showed that rates for obstetricians and family physicians were not significantly different. Increased odds of circumcision were found if the mother received an episiotomy (OR = 1.9, P < .001) or cesarean section (OR = 2.1, P < .001). Circumcised infants stayed in the hospital an average of one fourth of a day longer than did those who were not circumcised (mean difference, 0.26 days; 95% confidence interval, 0.16 to 0.36).
Conclusions:
Mother's insurance status and race as well as surgical interventions during delivery are related to circumcision. Associations with episiotomy and cesarean section suggest physician and/or parental preference for interventional approaches to health care. Generalizing the difference in hospital length of stay to the United States suggests an annual cost between $234 million and $527 million beyond charges for the procedure itself.
