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延迟包皮环切术对医疗系统的负担:一项回顾性研究。

Burden of Delayed Circumcision on Healthcare Systems: a Retrospective Study.

作者信息

Alsowayan Ossamah

机构信息

Department of Urology, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

出版信息

Med Arch. 2024;78(4):302-304. doi: 10.5455/medarh.2024.78.302-304.

Abstract

BACKGROUND

Circumcision is a surgical procedure that is performed for a variety of cultural, medical, and religious purposes. Carbonic Circumcision is a surgical procedure which has the potential to be performed in a public health setting and offers several advantages particularly in the prevention of disease.

OBJECTIVE

This study aims to evaluate the financial, medical, and sociodemographic impacts of delayed circumcision as compared to early circumcision.

METHODS

This retrospective study was carried after obtaining IRB approval from our institution (IRB-2024-01-814). Records of circumcision cases from January 2020 to January 2024 were reviewed comparing early circumcisions (within the first 90 days of life) done under local anesthesia with delayed circumcisions (after 180 days of life) done under general anesthesia.

RESULTS

A total of 192 patients were excluded due to various reasons: Hypospadias (57 cases), ambiguous genitalia with bilateral undescended testes (26 cases), penile web (22 cases), buried penis (12 cases), penoscrotal transposition (4 cases), and other systemic abnormalities (7 cases). Studies have shown multiple long term economic benefits when circumcision is done early on in life. The cost of circumcision performed later in life is relatively higher than that performed early. In older children, circumcision requires general anesthesia, hospital bed utilization and post operative care which significantly increases the direct cost of the procedure compared to a procedure that is done in an outpatient setting under local anesthesia.

CONCLUSION

Delayed circumcision translates into expedited healthcare costs while circumcising neonates fosters more overall affordable and less risky surgery. Appropriate measures should be taken from the side of the decision makers in order to endorse neonatal circumcision practices during such interventions where there is a disparity in healthcare equity, costs or patient outcomes..

摘要

背景

包皮环切术是一种出于多种文化、医学和宗教目的而进行的外科手术。二氧化碳激光包皮环切术是一种有可能在公共卫生环境中实施的外科手术,具有多种优势,尤其是在疾病预防方面。

目的

本研究旨在评估延迟包皮环切术与早期包皮环切术相比在经济、医学和社会人口统计学方面的影响。

方法

本回顾性研究在获得本机构的机构审查委员会批准(IRB - 2024 - 01 - 814)后进行。回顾了2020年1月至2024年1月期间包皮环切术病例记录,比较了在局部麻醉下进行的早期包皮环切术(出生后90天内)与在全身麻醉下进行的延迟包皮环切术(出生后180天以后)。

结果

共有192例患者因各种原因被排除:尿道下裂(57例)、双侧隐睾的生殖器模糊(26例)、阴茎蹼(22例)、埋藏阴茎(12例)、阴茎阴囊转位(4例)和其他全身异常(7例)。研究表明,在生命早期进行包皮环切术有多种长期经济效益。在生命后期进行包皮环切术的成本相对高于早期进行的成本。在年龄较大的儿童中,包皮环切术需要全身麻醉、住院床位使用和术后护理,与在门诊局部麻醉下进行的手术相比,这显著增加了手术的直接成本。

结论

延迟包皮环切术会导致医疗费用加速增加,而对新生儿进行包皮环切术则能带来更具总体可承受性且风险更低的手术。决策者应采取适当措施,以便在医疗保健公平性、成本或患者结果存在差异的此类干预措施中支持新生儿包皮环切术做法。

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本文引用的文献

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Neonatal Male Circumcision: Clearly Beneficial for Public Health or an Ethical Dilemma? A Systematic Review.
Cureus. 2024 Feb 23;16(2):e54772. doi: 10.7759/cureus.54772. eCollection 2024 Feb.
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Longitudinal Sociodemographic Analysis of Operative Circumcisions at Children's Hospitals.
Urology. 2022 Apr;162:84-90. doi: 10.1016/j.urology.2021.04.036. Epub 2021 May 14.
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