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Original Investigation |

Rates of Adverse Events Associated With Male Circumcision in US Medical Settings, 2001 to 2010

Charbel El Bcheraoui, PhD1,2,3; Xinjian Zhang, PhD2; Christopher S. Cooper, MD4; Charles E. Rose, PhD2; Peter H. Kilmarx, MD2; Robert T. Chen, MD, MA2
[+] Author Affiliations
1Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
2Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
3Institute for Health Metrics and Evaluation, University of Washington, Seattle
4Division of Pediatric Urology, The University of Iowa, Iowa City
JAMA Pediatr. 2014;168(7):625-634. doi:10.1001/jamapediatrics.2013.5414.
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Importance  Approximately 1.4 million male circumcisions (MCs) are performed annually in US medical settings. However, population-based estimates of MC-associated adverse events (AEs) are lacking.

Objectives  To estimate the incidence rate of MC-associated AEs and to assess whether AE rates differed by age at circumcision.

Design  We selected 41 possible MC AEs based on a literature review and on medical billing codes. We estimated a likely risk window for the incidence calculation for each MC AE based on pathogenesis. We used 2001 to 2010 data from SDI Health, a large administrative claims data set, to conduct a retrospective cohort study.

Setting and Participants  SDI Health provided administrative claims data from inpatient and outpatient US medical settings.

Main Outcomes and Measures  For each AE, we calculated the incidence per million MCs. We compared the incidence risk ratio and the incidence rate difference for circumcised vs uncircumcised newborn males and for males circumcised at younger than 1 year, age 1 to 9 years, or 10 years or older. An AE was considered probably related to MC if the incidence risk ratio significantly exceeded 1 at P < .05 or occurred only in circumcised males.

Results  Records were available for 1 400 920 circumcised males, 93.3% as newborns. Of 41 possible MC AEs, 16 (39.0%) were probable. The incidence of total MC AEs was slightly less than 0.5%. Rates of potentially serious MC AEs ranged from 0.76 (95% CI, 0.10-5.43) per million MCs for stricture of male genital organs to 703.23 (95% CI, 659.22-750.18) per million MCs for repair of incomplete circumcision. Compared with boys circumcised at younger than 1 year, the incidences of probable AEs were approximately 20-fold and 10-fold greater for males circumcised at age 1 to 9 years and at 10 years or older, respectively.

Conclusions and Relevance  Male circumcision had a low incidence of AEs overall, especially if the procedure was performed during the first year of life, but rose 10-fold to 20-fold when performed after infancy.

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