P3.382 Post-Neonatal Pediatric Circumcision in the United States, 2010

Abstract

Background: Male circumcision can protect against sexually transmitted infections, HIV, and urinary tract infections. The procedure is easier to perform during the neonatal period (< 28 days), with fewer complications and rarely requiring general anaesthesia. Few studies have estimated the number of circumcisions, or indications for the procedure, in the post-neonatal period (ages 1-18 years). Our objective was to compare these for neonatal and post-neonatal circumcisions. Method(s): We analysed MarketScan data, a database of billing claims from commercial health plans. We used circumcision procedural codes to identify all circumcisions in 2010, including neonatal circumcisions of males born to women enrolled in the health plans, and circumcisions of males aged 1-18 years. We assessed reasons for circumcision using diagnostic codes, and stratified the number of circumcisions and associated diagnosis by age. We estimated the neonatal circumcision rate. Result(s): Overall, 120,994 circumcisions were performed in 2010, with 113,740 (94%) in neonates and 7,254 (6.0%) in post-neonates. Among post-neonatal circumcisions, 67% were performed for boys < 3 years of age and of these 28% were elective. In contrast, among males 3 years and older, only 8% were elective. The neonatal circumcision rate was 113,740/182,503 (62%), and 92% were elective. Among 16,457 non-elective circumcisions for both neonates and post-neonates, the most frequent indications were phimosis (92%), balanitis (3%), hidden penis (2%), chordee (2%), and hypospadias (2%). Conclusion(s): Most post-neonatal circumcisions were performed among males < 3 years, and were 8.6 times higher than circumcisions among males 3 years and older. The large number of elective post-neonatal circumcisions in males < 3 years suggest that neonatal circumcision might be a missed opportunity for these boys. Delaying elective circumcision results in greater risk for the child, and a more costly procedure. Discussions with parents early in pregnancy might help them make an informed decision about circumcision of their child.