Rates of selected neonatal male circumcision-associated severe adverse events in the United States, 2007-2009
Presented by Charbel El Bcheraoui (United States).
C. El Bcheraoui1, J. Greenspan2, K. Kretsinger1, R. Chen1
1CDC, Division of HIV/AIDS Prevention, Atlanta, United States, 2SDI Health, Atlanta, United States
Background: Three African randomized controlled trials recently showed that adult male circumcision (MC) conferred approximately 50% protection against HIV acquisition. Several countries, including the United States, are updating their HIV prevention recommendations to include adult and neonatal MC. In the United States, nonrepresentative published cohort studies have reported rates of MC adverse events (AEs) ranging from 0.2 to 2.0%. Representative data on rates of MC AEs, particularly rare and severe AEs, are needed to guide these recommendations.
Methods: We retrospectively analyzed discharge data from any hospital setting (inpatient or hospital clinics) from SDIHealth, the largest U.S. consolidator of electronic healthcare reimbursement claims (eHRCs). SDIHealth obtains data on all patients from 21% of U.S. short-stay hospitals. We used a) International Classification of Diseases (ICD-9) codes to identify circumcised boys born between November 2007 and October 2009, and b) ICD-9 and Current Procedural Terminology (CPT) codes to identify selected AEs recorded during the birth hospitalization or in any subsequent hospital setting within 60 days of birth.
Results: During the 24 month observation period, 330,845 newborn circumcisions occurred during the birth hospitalization (approximately 12% of 1.4 million total annual infant MC in the US). Within 60 days of these circumcisions, 3 partial penile amputations (9.0/million circumcisions), 78 penile post-circumcision adhesions (2.3/10,000 circumcisions) and 243 repairs of incomplete circumcisions (7.3/10,000 circumcisions) were recorded for 308 unique patients in hospital settings (9.8/10.000 circumcisions overall). No complete penile amputation or deaths were recorded.
Conclusions: We found low incidence rates of the selected AEs after MC in hospital settings, taking advantage of administrative eHRC datasets, with large sample sizes and longitudinal design. We plan next to study other MC AEs, such as bleeding and infections, that may be treated in other outpatient settings, to provide a better understanding of the risks of MC for parents and providers.
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