Is Circumcision Revision Becoming More Common?

Saturday, October 15, 2011: 1:25 PM
210 (Boston Convention and Exhibition Center)
Paul J. Kokorowski, M.D., M.P.H.1, Jonathan C. Routh, M.D., M.P.H.2, Dionne A. Graham, Ph.D.3 and Caleb P. Nelson, M.D., M.P.H.2, (1)Urology, Children's Hospital Boston, Boston, MA, (2)Department of Urology, Children's Hospital Boston, Boston, MA, (3)Clinical Research Program, Children's Hospital Boston, Boston, MA

Purpose: Anecdotal experience suggests that revision circumcision (RC) is increasingly common, but no data exists regarding national RC trends or demographics. We sought to determine if the incidence of RC at free-standing children's hospitals was increasing over time. 

Methods: We performed a search of the Pediatric Health Information Systems (PHIS) database to identify pediatric patients undergoing specific penile procedures (RC, primary non-newborn circumcision (PC) or lysis of penile adhesions (LPA)) from 2003-2009. Since CPT codes for both LPA and RC were introduced in 2002, LPA served as a control for increases associated with introduction of a new code.  Changes in RC rates compared to PC or LPA over time were compared using Poisson regression. 

Results: We identified 34,568 patients who underwent RC, PC or LPA.  Of these, 5,632 underwent RC, 25,768 PC, and 3,168 LPA. From 2004 to 2009 the rate of RC per total male ambulatory surgical volume increased by 119%, significantly more than PC (19%; p<.001) or LPA (37%; p<.001). Urologists performed 76% of RC procedures and 12% were performed in conjunction with other genitourinary (GU) procedures. Boys undergoing RC were predominately white (60%) and privately insured (62%).

Conclusions: There was an increase in the relative rate of RC performed at PHIS hospitals from 2004-2009. This increase was disproportionately greater for RC than for either PC or LPA, reflecting either increasing desire for RC among parents or, potentially, decreasing quality of PC.