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INTRODUCTION AND OBJECTIVES: Circumcision remains a very common procedure in the United States. Published complication rates are lower than clinical practice suggests. We aimed to use a population-based claims database to define the regional 2 year complication rate in boys who underwent circumcision. We hypothesized that this rate would be between 1 and 5%.

METHODS: The Utah All-Payer Claims Database (UAPCD) contains data from health insurance carriers, Medicaid, and third party administrators in Utah. The data consist of medical and pharmacy claims as well as insurance and health care provider data, and all residents in the State of Utah are included unless they opt out. The UAPCD was queried for all male patients aged 0-730 days undergoing circumcision (CPT 54150, 54160 and 54161) during the year 2013. Subjects were censored if they had less than 2 years of post-procedure data. Demographic, medical and procedure-specific data was abstracted. ICD-9 and -10 codes were used to identify infectious, bleeding, urethral, skin and wound healing-related complications. Encounters for circumcision revision (CPT 54161, 54163), or lysis of penile adhesions (CPT 54162) were noted.

RESULTS: In 2013 there were 26,069 male births and 6298 circumcisions were captured. The mean age at circumcision was 9.8 days for those who had circumcision with a clamp (CPT 54150), 16.3 days for those who had a surgical circumcision other than clamp (CPT 54160) and 309.3 days for boys who had a formal circumcision after the neonatal period (CPT 54161). 725 (11.5%) complications were identified. The two most common complications were phimosis in 433 (6.9%) and other wound related complications such as acquired torsion, buried penis and edema in 168 (2.7%). Infectious/inflammatory (1.2%), urethral (0.5%), and bleeding (0.3%) complications were rare. 101 (1.6%) patients underwent surgical revision or lysis of penile adhesions. Complications did not differ significantly between patients who h the original circumcision in a hospital vs. an outpatient setting (p=0.33) or in an urban vs. rural location (p=0.22). When adjusted for healthcare setting and location, the difference in complications between patients less than 90 compared to those 90 to 730 days old was not significant.

CONCLUSIONS: The incidence of post-circumcision complications at 2 years is much higher than expected at 11.5%, but does not appear to be influenced by age at circumcision, healthcare setting or a rural vs. urban location. A minority of subjects needed reoperation during the ensuing 2 years.

Source of Funding: None