Abstract
Objective
To characterize elective, post-neonatal operative circumcision at US children's hospitals,
in the context of established sociodemographic disparities in access to neonatal circumcision.
Methods
A retrospective cohort study was performed of boys undergoing elective, operative
circumcision at the 23 Pediatric Health Information System (PHIS) hospitals who contributed
data from 2004-2018. Boys > = 36 months’ and those with congenital anomalies of the
penis were excluded. Bivariate statistics were used to compare the circumcision cohort
to a referent cohort of boys undergoing other ambulatory surgery or having an observational
hospital stay.
Results
The annual median number of operative circumcisions per hospital increased during
the study (72 [IQR 54-162] to 136 [IQR 88-266], P = .003). Boys undergoing circumcision were mostly non–Hispanic White (46.7%) or non–Hispanic
Black (30.9%), in the lowest income quartile (26.6%), from the Southern US (51.5%),
and publicly-insured (60.5%). When compared to the reference cohort, boys undergoing
circumcision were more likely to be non–Hispanic Black (30.9 vs 15.7%, P = .001) and publicly-insured (60.5 vs 45.9%, P = . 001).
Conclusion
The number of post-neonatal operative circumcisions performed at US children's hospitals
nearly doubled from 2004 to 2018. Study findings suggest an emerging healthcare disparity,
with non–Hispanic Black boys of lower socioeconomic status undergoing more post-neonatal
operative circumcisions that are more expensive and higher risk.
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Article info
Publication history
Published online: May 14, 2021
Accepted:
April 28,
2021
Received:
January 22,
2021
Footnotes
Financial Disclosure: Dr. Emilie Johnson was funded by the Urology Care Foundation 2019-2021 Societies for Pediatric Urology Sushil Lacy, MD Research Scholar Award
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
