Abstract
Background: A significant proportion of boys present to surgical specialists later in infancy/early childhood for elective operative circumcision despite the higher procedural risks. This study aims to assess physician perspectives on access to neonatal circumcision (NC) across the United States and identify potential reasons contributing to disparities in access. Materials and methods: A cross-sectional survey was electronically distributed to physician members of the Societies for Pediatric Urology and the American Academy of Pediatrics Section on Hospital Medicine. Hospital characteristics and circumcision practices were assessed. Associations between NC availability and institutional characteristics were evaluated using chi-squared testing and multivariable logistic regression. Qualitative analyses of free-text comments were performed. Results: A total of 367 physicians responded (129 urologists [41%], 188 pediatric hospitalists [59%])). NC was available at 86% of hospitals represented. On univariate and multivariate analysis, the 50 hospitals who did not offer NC were more likely to be located in the Western region (odds ratio [OR]=8.33; 95% confidence interval [CI]=3.1-25 vs Midwest) and in an urban area (OR=4.2; 95% CI=1.6-10 vs suburban/rural) compared with hospitals that offered NC. Most common reasons for lack of availability included not a birth hospital (N=22, 47%), lack of insurance coverage (N=8, 17%), and low insurance reimbursement (N=7, 15%). Institutional, regional, or provider availability (68%), insurance/payment (12.4%), and ethics (12.4%) were common themes in the qualitative comments. Conclusions: Overall availability of neonatal circumcision varied based on hospital characteristics, including geography. Information from this survey will inform development of interventions designed to offer NC equitably and comprehensively.
Highlights
Circumcisions are the most commonly performed pediatric surgical procedure [1]
The present study aims to assess physician perspectives on access to neonatal circumcision at hospitals throughout the United States (US), and identify potential underlying reasons contributing to disparities in access to the procedure
Cohort characteristics A total of 367 physicians (165 pediatric urologists [45%], 202 pediatric hospitalists [55%]; Table 1) responded to the survey, with an estimated response rate of 9.5%
Summary
For families who seek circumcision for their sons, health benefits include the decreased risk of urinary tract infections, sexually transmitted infections and penile cancer. Naha et al BMC Urol (2021) 21:148 lower-income families have lower rates of circumcision in comparison to boys from families with higher income [11]. This suggests that there are barriers in access underlying the differing rates of neonatal circumcision. In states and years without Medicaid coverage, Black infants had lower odds of undergoing neonatal circumcision [13]. This study aims to assess physician perspectives on access to neonatal circumcision across the United States and identify potential reasons contributing to disparities in access
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