Atkin G K, Butler C, Broadhurst J, Khan A, Nataraj R, Madden N, Haddad M, Clarke S A
Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Trust, London, UK.
Ann R Coll Surg Engl. 2009 Nov;91(8):693-6. doi: 10.1308/003588409X12486167520957. Epub 2009 Sep 25.
Primary care trust (PCT) funding of a ritual circumcision service has recently been withdrawn from our unit, raising concerns that this may result in greater morbidity from community circumcision. The aims of this study were to document our circumcision practice before and after the withdrawal of PCT funding and to determine its effect on the morbidity from circumcision. In addition, we wanted to survey all paediatric surgical centres in the British Isles to ascertain how many still offer a ritual circumcision service.
We retrospectively reviewed our circumcision practice for 1 year prior to the removal of UK Government funding, and then performed a prospective audit of our practice for the 12 months following funding withdrawal. An e-mail survey was also performed of all paediatric surgical units to determine the ritual circumcision service provision throughout the British Isles.
A total of 213 boys underwent circumcision during the 12 months prior to the withdrawal of funding, of which 106 cases (50%) were ritual circumcisions. After funding withdrawal, 99 boys underwent circumcision, of which 98 cases (99%) were for medical reasons. A similar number of boys were re-admitted after a hospital circumcision during the two review periods (5 versus 4 patients), whereas the number admitted following a community circumcision rose after funding withdrawal (6 versus 11 patients). Only a third of British paediatric surgical centres offer a ritual circumcision service, and a significant pro- portion of these were either providing the service without PCT funding, or were reconsidering their decision to continue.
PCT funding withdrawal for ritual circumcision had an impact on our unit's procedural case volume. This represented a cost saving to the trust, despite a higher rate of admissions for postoperative complications. There is an inequality in healthcare provision throughout the British Isles for ritual circumcision, and we feel it is vital to offer support and training to medical and non-medical practitioners who are being asked to perform a greater number of circumcisions in the community.
我们单位的初级保健信托基金（PCT）对一项割礼仪式服务的资助最近已被撤销，这引发了人们对社区割礼可能导致更高发病率的担忧。本研究的目的是记录PCT资助撤销前后我们的割礼手术情况，并确定其对割礼发病率的影响。此外，我们想对不列颠群岛的所有儿科手术中心进行调查，以确定仍有多少中心提供割礼仪式服务。
我们回顾性分析了英国政府资助撤销前1年的割礼手术情况，然后对资助撤销后的12个月进行了前瞻性审计。我们还通过电子邮件对所有儿科手术科室进行了调查，以确定整个不列颠群岛的割礼仪式服务提供情况。
在资助撤销前的12个月里，共有213名男孩接受了割礼，其中106例（50%）是割礼仪式。资助撤销后，有99名男孩接受了割礼，其中98例（99%）是出于医疗原因。在两个审查期内，医院割礼后再次入院的男孩数量相似（分别为5例和4例），而社区割礼后入院的男孩数量在资助撤销后有所增加（分别为6例和11例）。只有三分之一的英国儿科手术中心提供割礼仪式服务，其中很大一部分要么在没有PCT资助的情况下提供该服务，要么正在重新考虑继续提供该服务的决定。
PCT对割礼仪式资助的撤销对我们单位的手术病例数量产生了影响。尽管术后并发症的入院率较高，但这为信托基金节省了成本。整个不列颠群岛在割礼仪式的医疗服务提供方面存在不平等现象，我们认为为那些被要求在社区进行更多割礼手术的医疗和非医疗从业者提供支持和培训至关重要。
