Abstract：
OBJECTIVE: To compare penile problems in circumcised relative to uncircumcised boys, and to determine which providers performing the circumcision have fewer post-circumcision problems.
METHODS: CPT codes in the 2011-2020 MarketScan database were used to identify boys who had a circumcision. Uncircumcised control subjects of the same age, state of residence, and insurance type were selected. The primary outcome was a penile problem, defined as penis-specific infection, inflammation, and urethral stricture/stenosis, among others. The secondary outcomes were procedure-related complications limited to 28 days after circumcision, and whether post-circumcision problems varied by the clinician performing the procedure. ICD-9/10 diagnostic codes were used to identify these problems.
RESULTS: We identified ∼850,000 cases and ∼850,000 matched controls. Overall, the rate of penile problems within the first five years of life was 1.7% in circumcised boys versus 0.5% in uncircumcised boys (p < 0.05). Multivariable regression models showed that the risk of penile problems was 2.9-fold higher among circumcised compared to uncircumcised males (95%CI [2.8-3], p < 0.001). Compared to males circumcised by pediatricians, those circumcised by surgeons had 2.1-fold higher penile problems in the year after circumcision (95% CI [2-2.3], p < 0.001). Procedure-related complications within 28 days of circumcision were infrequent (0.5%), with the most common being penile edema (0.2%).
CONCLUSIONS: Penile problems are very infrequent in boys in the first five years of life. However, when they occur, they are 3x more likely to occur in circumcised boys relative to uncircumcised boys. Penile problems are more likely to occur in boys circumcised by surgeons.
METHODS: Level II.
METHODS: Prognosis study.
METHODS: CPT codes in the 2011-2020 MarketScan database were used to identify boys who had a circumcision. Uncircumcised control subjects of the same age, state of residence, and insurance type were selected. The primary outcome was a penile problem, defined as penis-specific infection, inflammation, and urethral stricture/stenosis, among others. The secondary outcomes were procedure-related complications limited to 28 days after circumcision, and whether post-circumcision problems varied by the clinician performing the procedure. ICD-9/10 diagnostic codes were used to identify these problems.
RESULTS: We identified ∼850,000 cases and ∼850,000 matched controls. Overall, the rate of penile problems within the first five years of life was 1.7% in circumcised boys versus 0.5% in uncircumcised boys (p < 0.05). Multivariable regression models showed that the risk of penile problems was 2.9-fold higher among circumcised compared to uncircumcised males (95%CI [2.8-3], p < 0.001). Compared to males circumcised by pediatricians, those circumcised by surgeons had 2.1-fold higher penile problems in the year after circumcision (95% CI [2-2.3], p < 0.001). Procedure-related complications within 28 days of circumcision were infrequent (0.5%), with the most common being penile edema (0.2%).
CONCLUSIONS: Penile problems are very infrequent in boys in the first five years of life. However, when they occur, they are 3x more likely to occur in circumcised boys relative to uncircumcised boys. Penile problems are more likely to occur in boys circumcised by surgeons.
METHODS: Level II.
METHODS: Prognosis study.
摘要：
目的：比较受割礼的男孩与未受割礼的男孩的阴茎问题，并确定哪些进行包皮环切术的提供者在包皮环切术后的问题较少。
方法：使用2011-2020MarketScan数据库中的CPT代码来识别包皮环切术的男孩。同龄的未割礼对照受试者，居住国,选择了保险类型。主要结果是阴茎问题，定义为阴茎特异性感染，炎症,尿道狭窄/狭窄,在其他人中。次要结果是包皮环切术后28天的手术相关并发症，以及包皮环切后的问题是否因执行手术的临床医生而异。ICD-9/10诊断代码用于识别这些问题。
结果：我们确定了~850,000个病例和~850,000个匹配的对照。总的来说,受包皮环切的男孩在生命的前五年内的阴茎问题发生率为1.7％，而未受包皮环切的男孩为0.5％（p<0.05）。多变量回归模型显示，与未接受包皮环切术的男性相比，接受包皮环切术的男性发生阴茎问题的风险高2.9倍（95CI[2.8-3]，p<0.001)。与儿科医生割礼的男性相比，在包皮环切术后的一年中，由外科医生进行包皮环切术的人的阴茎问题增加了2.1倍（95％CI[2-2.3]，p<0.001)。包皮环切术28天内手术相关并发症很少见（0.5%），最常见的是阴茎水肿(0.2%)。
结论：男孩在生命的前五年中很少出现阴茎问题。然而,当它们发生时，与未割礼的男孩相比，割礼的男孩发生割礼的可能性要高3倍。阴茎问题更可能发生在由外科医生割礼的男孩身上。
方法：二级。
方法：预后研究。
方法：使用2011-2020MarketScan数据库中的CPT代码来识别包皮环切术的男孩。同龄的未割礼对照受试者，居住国,选择了保险类型。主要结果是阴茎问题，定义为阴茎特异性感染，炎症,尿道狭窄/狭窄,在其他人中。次要结果是包皮环切术后28天的手术相关并发症，以及包皮环切后的问题是否因执行手术的临床医生而异。ICD-9/10诊断代码用于识别这些问题。
结果：我们确定了~850,000个病例和~850,000个匹配的对照。总的来说,受包皮环切的男孩在生命的前五年内的阴茎问题发生率为1.7％，而未受包皮环切的男孩为0.5％（p<0.05）。多变量回归模型显示，与未接受包皮环切术的男性相比，接受包皮环切术的男性发生阴茎问题的风险高2.9倍（95CI[2.8-3]，p<0.001)。与儿科医生割礼的男性相比，在包皮环切术后的一年中，由外科医生进行包皮环切术的人的阴茎问题增加了2.1倍（95％CI[2-2.3]，p<0.001)。包皮环切术28天内手术相关并发症很少见（0.5%），最常见的是阴茎水肿(0.2%)。
结论：男孩在生命的前五年中很少出现阴茎问题。然而,当它们发生时，与未割礼的男孩相比，割礼的男孩发生割礼的可能性要高3倍。阴茎问题更可能发生在由外科医生割礼的男孩身上。
方法：二级。
方法：预后研究。
