Low rates of adverse events with male circumcision in infancy

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1. The rate of adverse events from male circumcision in infants less than one year of age was low (0.40%). 

2. However, the incidence of adverse events was approximately 20 times higher (9.06%) for males circumcised at age 1 to 9 years, and approximately 10 times higher (5.31%) at age 10 or older. 

Evidence Rating Level: 2 (Good)            

Study Rundown: In 2012, the American Academy of Pediatrics stated in published guidelines that the benefits of male circumcision (MC) justify access to the procedure for families who choose it. It has been recently debated if MC should be a public health intervention based on randomized controlled trials showing protective effect against the human immunodeficiency virus. This study showed that in infants less than 1 year old, the rate of adverse events (AE) from MC was very low. However, the rate of AE increased with when MC was performed after the first year of age.

Strengths of the study include the large number of cases included and a large number of possible adverse events identified from a literature search. Weaknesses of the study include its retrospective nature. Moreover, data was collected from an administrative database using ICD-9 and CPT codes for possible MC related AEs. Since data was collected from a billing database, a circumcision that was not covered by a third party payer would not be included.

Click to read the study, published today in JAMA Pediatrics

Relevant Reading:  Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial

In-Depth [retrospective cohort]:  This retrospective cohort study examined data collected from a large administrative claims data set, including hospitals from 48 states, from 2001 to 2010. Records were available for 1,400,920 circumcisions. 41 possible adverse events were identified based on a PubMed literature search for the terms “circumcision” and “adverse events”. An AE was considered probably related to MC based on the incident risk ratio (IRR) and incident rate difference (IRD) between circumcised and uncircumcised newborn males. Data was analyzed from 3 age groups: males circumcised in the first year of life, at age 1 to 9 years, or at 10 years or older.

Of the 1.4 million circumcised males, 95.3% were circumcised in infancy (less than 1 year old), 2% at age 1 to 9 years, and 2.7% at 10 years or older. The incidence of probable AEs was 0.40% (95% CI, 0.39%-0.41%) for boys circumcised at less than 1 year of age, 9.06% (95% CI, 8.73%-9.40%) for age 1-9, and 5.31% (95% CI, 5.09%-5.55%). For boys circumcised at age 1 to 9 years, the highest IRR was for division of penile adhesions (IRR=67.64). For boys circumcised after age 10, the highest IRR was for inflammatory disease of the penis (IRR=112.06).

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