The Northeastern Society of Plastic Surgeons

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Risk of Revision Surgery After Newborn Circumcision is about 5%
Jenna Winebaum, MD1, Max Maizels, MD2, David Chalmers, MD3.
1Tufts Medical Center, Boston, MA, USA, 2Lurie Children's Hospital, Chicago, IL, USA, 3Maine Medical Center, Portland, ME, USA.

Introduction: Routine newborn circumcision is the most commonly performed surgery done on healthy newborn boys. As such, complications are expected to be low, but there are no studies to show the incidence of such complications. In order to provide fair parent counseling it is important to know this incidence. The purpose of this study is to determine the risk of revision for boys who undergo newborn circumcision and also to identify associated risk factors.  
 
Materials and Methods:  We retrospectively enrolled into this study consecutive newborn boys who had circumcision done by one month of age at Maine Medical Center (MMC). The study was done over the 16months between December, 2012 to April, 2013. The outcome measures were: gestational age, weight, age at the time of procedure, circumcision technique (GOMCO vs. Mogen), provider type (attending vs. trainee), and if a revision was performed under general anesthesia.  Study subjects with at least six months follow up within MMC were included for analysis. The data was analyzed by subject group (revision was done vs. no revision done). The rate of circumcision revision was calculated and compared across the groups (Fisher Exact Test). Subjects with inadequate follow up or documentation were excluded.
Results: A total of 310 consecutive circumcision procedures were performed during the study interval and 258 (83%) were included for analysis; 52(17%) sought follow up care outside MMC and are excluded. There were 12 (4.65%) cases which underwent circumcision revision which required general anesthesia at a mean age of 24 months (range 6-32 months).  Procedures included circumcision revisions (8) lysis of penile adhesion (6), or excision of penis skin bridges (4). There were only two risk factors associated with performance of revision as 1. Weight at newborn procedure is small or large for GA (i.e., <2.5kg or >4kg, respectively) and provider type performing circumcision (4/12).

No RevisionRevisionSignificance
Trainee254 (4/29)(13.8%)
Attending2218 (8/229) (3.5%)
total24612/258 (4.7%)p= 0.03
Small or large GA178 (8/25)(32.0%)
Appropriate for GA2294 (4/233)((1.7%)
total24612/258 (4.7%)p < 0.01

Conclusions: This is the first series to show the risk of revision following newborn circumcision is about 5%.  The risk factors which were significantly associated with revision included small or large for gestational age and provider type as trainee performing the procedure. We plan to determine if merely informing circumcision providers of this information may lead to a reduced rate of revision.


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