Contact: Venkata Jayanthi
Circumcisions In Doctors' Offices As Safe As Those In Hospitals
COLUMBUS, Ohio -- New research shows that boys
circumcised in a doctor's office fare just as well
after the
procedure as those who were circumcised in a hospital
operating room.
Researchers compared the medical and economic
outcomes of 532 circumcisions performed either in a
doctor's office or an operating room. Only four
patients in
each group experienced complications. The cost savings
in
having the circumcisions done in the doctor's office
were
estimated at $1,609 per procedure, for an overall
savings
of $184,713 annually in this group of patients.
"There are tremendous savings by doing circumcisions
under local anesthesia and avoiding a trip to the
operating
room," said Venkata Jayanthi, a clinical assistant
professor
of surgery at Ohio State University and Children's
Hospital
in Columbus.
Jayanthi co-authored the study with Joanna Burns, a
registered nurse at Children's Hospital, and Stephen
Koff,
a professor of surgery at Ohio State. The research
appears
in a recent issue of the Journal of Urology.
The researchers divided the boys into two groups --
287
infants aged 3 days to 9 months were circumcised in
the
doctor's office under local anesthesia, while 245 boys
aged
6 months to 15 years were circumcised in an operating
room under general anesthesia. The circumcisions took
place at Children's Hospital within a 30-month period.
Boys in the United States are usually circumcised
within the
first few days of life. There were several reasons
given for
those in the office group for not having undergone
circumcision immediately after birth. These included
being
born prematurely (105); penile abnormalities (40); the
child
was an adopted baby (14); and a short postnatal
hospital
stay (7). Why those in the operating room group had
not
been circumcised wasn't known since patient charts
often
lacked such details. Jayanthi said the main reason he
and
his colleagues started doing in-office circumcisions
was "to
keep our operating room time free."
Four patients from each group had complications. After
the
office circumcision, one boy developed an infection,
one
had some bleeding and two had recessed penises, which
required an operation under general anesthesia. Four
patients in the operating room group had bleeding,
which
was managed by a temporary pressure bandage.
He and his colleagues also looked at the price
difference
between the office and operating room procedures. They
excluded the surgeon's fee of $425 in their analysis
because this fee is the same regardless of where the
procedure took place. The average office cost of $196
covered the fees for use of the office and the
equipment.
The $1,805 average operating-room fee covered general
anesthesia and "global hospital fees," which included
facilities, equipment and the salaries of the
attending nurses
and technicians.
"In the hospital, it's an operation -- not just a
circumcision,"
Jayanthi said. "There are tremendous amounts of hidden
costs at that level. The smaller charge for an office
procedure helps defray the cost of the attendants and
the
equipment required for a circumcision."
For the office procedures, doctors injected each boy
with a
local anesthetic of 1 percent lidocaine. Each baby was
placed on a standard circumcision restraining board. A
Plastibell device was placed over the penis. This
bell-shaped device allowed the foreskin to be pulled
back
and tied with a ligature. This essentially crushed the
skin
and controlled the bleeding. The bell fell off once
the
wound healed.
Although it may sound painful, about "half of all boys
will
be relatively comfortable during the office
procedure,"
Jayanthi said, adding that some babies cried during
the
entire office procedure. However, these complaints
could
have been due to being restrained on the circumcision
restraining board.
In the United States, many infants circumcised at
birth do
not receive anesthesia. A study in the Dec. 24, 1997
issue
of the Journal of the American Medical Association
showed that infants receiving local anesthesia cried
less and
had lower heart rates during and after the procedure
when
compared with those who did not receive anesthesia.
About 60 to 80 percent of all boys born each year in
the
United States are circumcised. It's the "cultural
norm" in
this country, Jayanthi said, citing that studies in
some
countries have shown an increased risk of urinary
tract
infections and HIV transmission in men who have not
been
circumcised.
However, the American Academy of Pediatrics recently
issued a statement indicating that the mild increase
in risk of
infections does not warrant routine circumcision of
all boys
and that there is no medical reason for newborn
circumcision. The AAP also suggests that local
anesthesia
be used to decrease a boy's pain should the parent
elect to
have their son circumcised.
"Most parents in the U.S. don't get their boys
circumcised
because they are afraid that their child will develop
an
infection; rather, they get the babies circumcised
because
their fathers usually are," Jayanthi said. "There is
also the
false perception that a circumcised boy will be easier
to
care for."
Jayanthi said that this study suggests that if parents
want
their son to be circumcised, yet the circumcision
cannot be
performed immediately after birth, the procedure
should be
done in an office setting as soon as it is medically
safe.
Written by Holly Wagner, 614-292-8310;
rjayanth@chi.osu.edu
614-722-6625
Ohio State
University