Research · May 12, 2014
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- This study investigated the adverse events associated with male circumcision in 1.4 million patients (93% newborn) from 2001 to 2010 in the US, comparing the incidence rate difference for circumcised vs uncircumcised males. The total incidence of adverse events was less than 0.5%. The lowest rate of adverse events was 0.76 per million for stricture of male genital organs, and the highest rate of adverse events was 703.23 per million for repair of incomplete circumcision. The rate of adverse events increased 10- to 20-fold in circumcisions performed after the age of 1 compared with those done in children under 1.
- It is critical that parents be fully aware of the risks and benefits of male circumcision. Overall, circumcision is safe, particularly when performed on infants.
– Moshe Ornstein, MD Full Story Journal Reference
ABSTRACT
IMPORTANCE
Approximately 1.4 million male circumcisions (MCs) are performed annually in US medical settings. However, population-based estimates of MC-associated adverse events (AEs) are lacking.
OBJECTIVES
To estimate the incidence rate of MC-associated AEs and to assess whether AE rates differed by age at circumcision.
DESIGN
We selected 41 possible MC AEs based on a literature review and on medical billing codes. We estimated a likely risk window for the incidence calculation for each MC AE based on pathogenesis. We used 2001 to 2010 data from SDI Health, a large administrative claims data set, to conduct a retrospective cohort study.
SETTING AND PARTICIPANTS
SDI Health provided administrative claims data from inpatient and outpatient US medical settings.
MAIN OUTCOMES AND MEASURES
For each AE, we calculated the incidence per million MCs. We compared the incidence risk ratio and the incidence rate difference for circumcised vs uncircumcised newborn males and for males circumcised at younger than 1 year, age 1 to 9 years, or 10 years or older. An AE was considered probably related to MC if the incidence risk ratio significantly exceeded 1 at P < .05 or occurred only in circumcised males.
RESULTS
Records were available for 1 400 920 circumcised males, 93.3% as newborns. Of 41 possible MC AEs, 16 (39.0%) were probable. The incidence of total MC AEs was slightly less than 0.5%. Rates of potentially serious MC AEs ranged from 0.76 (95% CI, 0.10-5.43) per million MCs for stricture of male genital organs to 703.23 (95% CI, 659.22-750.18) per million MCs for repair of incomplete circumcision. Compared with boys circumcised at younger than 1 year, the incidences of probable AEs were approximately 20-fold and 10-fold greater for males circumcised at age 1 to 9 years and at 10 years or older, respectively.
CONCLUSIONS AND RELEVANCE
Male circumcision had a low incidence of AEs overall, especially if the procedure was performed during the first year of life, but rose 10-fold to 20-fold when performed after infancy.
JAMA Pediatrics
Rates of Adverse Events Associated With Male Circumcision in US Medical Settings, 2001 to 2010
JAMA Pediatr 2014 May 12;[EPub Ahead of Print], C El Bcheraoui, X Zhang, CS Cooper, CE Rose, PH Kilmarx, RT Chen