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

Abstract

Importance Over 1.4 million male circumcisions are performed annually in U.S. medical settings. However, population-based estimates of male circumcision associated adverse events are lacking. Objectives To estimate the incidence rate of male circumcision associated adverse events, and assess whether adverse event rates differed by age at circumcision. Design We selected 41 possible male circumcision adverse events based on literature review and medical billing codes. We estimated a likely risk window for incidence calculation for each male circumcision adverse event based on pathogenesis. We used 2001 – 2010 data from SDIhealth, a large administrative claims dataset, to conduct a retrospective cohort study. Setting SDIhealth provided administrative claims data from inpatient and outpatient U.S. medical settings. Main outcome measures For each adverse event, we calculated incidence per million male circumcisions. We compared incidence risk ratio and incidence rate difference for: a) circumcised vs. uncircumcised newborn males, and b) males circumcised at ≤1 year, 1–9 years, or ≥10 years of age. An adverse event was considered probably related to male circumcision if the incidence risk ratio significantly exceeded one at p<0.05 or occurred only in circumcised males. Results Records were available for 1,400,920 circumcised males, 93.3% as newborns. Of the 41 possible male circumcision adverse events, 16 (39%) were probable. Incidence of total male circumcision adverse event was slightly less than half percent. Rates of potentially serious male circumcision adverse events ranged from 0.76 per million male circumcision (95% CI: 0.10 – 5.43) for stricture of male genital organs to 703.23 per million male circumcision (95% CI: 659.22 – 750.18) for repair of incomplete circumcision. Compared to males circumcised at ≤1 year of age, the incidence was approximately 20- and 10-fold greater for males circumcised between 1 – 9 years and those ≥10 years of age, respectively. Conclusions and Relevance male circumcision had a relatively low incidence of adverse events overall, especially if the procedure was performed during the first year of life, but rose 10–20 fold when performed after infancy.

Expertise and Ideology in Statistical Evaluation of Circumcision for Protection against HIV Infection

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