Jacobson Deborah L, D'Oro Anthony, Abdullah Fizan, Barsness Katherine A, Liu Dennis B, Maizels Max, Rosoklija Ilina, Johnson Emilie K
Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL.
Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Surgery, Northwestern University, Chicago, IL.
Urology. 2020 Jun;140:143-149. doi: 10.1016/j.urology.2020.01.043. Epub 2020 Mar 9.
To determine caregiver-reported reasons for delay of desired neonatal circumcision.
Caregivers requesting elective outpatient circumcision at two urban tertiary care hospitals were surveyed from 1/2017 to 12/2018. Boys >3 years and those with abnormal penile anatomy were excluded. Patient/parent demographics, insurance status, comorbidities, birth history, family history, reasons circumcision was desired, and reasons for circumcision delay were obtained.
Surveys were completed by 206/229 caregivers (90% response rate). Respondents were primarily mothers (74%) who identified as African-American (62%). Eligible boys presented at a median 7.5 months [0.3-35.6] and were predominantly African-American (63%), publicly-insured at birth (83%), and publicly-insured at present (86%). 80% were full-term. 83% had no comorbidities. Most caregivers (84%) requested inpatient circumcision, primarily for penile cleanliness (75%) and infection prevention (72%). Common reasons for delay included neonatal circumcision not being performed by the birth physician/hospital (26%) and prematurity (16%). Publicly-insured boys were more likely to encounter delays related birth physician/hospital not performing circumcisions (P = .02). Non-Caucasian/mixed race boys were less likely to be eligible for circumcision without general anesthesia (P = .004). In 108 cases (52%), circumcision was requested for full-term boys without comorbidities. Of these, 72 (35% of the cohort) now require general anesthesia to undergo circumcision.
Among 206 boys experiencing circumcision delay, most were full-term, African-American, and publicly-insured. Common reasons for delay included neonatal circumcision not being performed by the birth hospital/physician and prematurity. General anesthesia could have been avoided in >35% of boys if circumcision was performed at birth.
确定照顾者报告的期望新生儿包皮环切术延迟的原因。
2017年1月至2018年12月期间，对两家城市三级医疗医院中要求进行择期门诊包皮环切术的照顾者进行了调查。排除3岁以上男孩及阴茎解剖结构异常的男孩。获取了患者/家长的人口统计学信息、保险状况、合并症、出生史、家族史、期望进行包皮环切术的原因以及包皮环切术延迟的原因。
229名照顾者中有206名完成了调查（回复率90%）。受访者主要是母亲（74%），其中非裔美国人占62%。符合条件的男孩就诊时的中位年龄为7.5个月[0.3 - 35.6]，主要为非裔美国人（63%），出生时参加公共保险的占83%，目前参加公共保险的占86%。80%为足月儿。83%无合并症。大多数照顾者（84%）要求进行住院包皮环切术，主要原因是阴茎清洁（75%）和预防感染（72%）。延迟的常见原因包括出生医生/医院未进行新生儿包皮环切术（26%）和早产（16%）。参加公共保险的男孩更有可能遇到与出生医生/医院未进行包皮环切术相关的延迟（P = 0.02）。非白种人/混血男孩在不进行全身麻醉的情况下进行包皮环切术的可能性较小（P = 0.004）。在108例（52%）病例中，要求对无合并症的足月儿进行包皮环切术。其中，72例（占队列的35%）现在需要全身麻醉才能进行包皮环切术。
在206名经历包皮环切术延迟的男孩中，大多数为足月儿、非裔美国人且参加公共保险。延迟的常见原因包括出生医院/医生未进行新生儿包皮环切术和早产。如果在出生时进行包皮环切术，超过35%的男孩本可避免全身麻醉。
