O2183: Moving the Needle to Reduce Adverse Neonatal Circumcision Outcomes (ANCOs) - Using Demographic and Clinical Data to Inform Improved Education

Background: Neonatal circumcision is the most frequently performed surgical procedure in boys and is associated with an incidence of adverse neonatal circumcision outcomes (ANCOs) ranging from 1%-20%. To inform our approach to reducing ANCOs in our community, we sought to understand the demographics and clinical profile of such cases. Herein we show such data by utilizing the pediatric health care system in Madison, WI in which two birthing hospitals are served by three pediatric urology staff at a large tertiary care center.

Methods: Design.
We reviewed our health system records to determine the prevalence of revision after neonatal circumcision and to probe for demographic factors associated with ANCO. Our goal was to use these results to inform education-based efforts to reduce ANCOs.

We retrospectively reviewed all patients undergoing surgical procedures which coded for circumcision revision (CPT 54161, 54163) or lysis of penile adhesions (CPT 54162) in our healthcare system during a 5-year period (01/01/2016 to 10/26/2020). Case charts were then reviewed to analyze which demographics differences could be related to ANCOs.

Results: During this period, there were 11,060 neonatal circumcisions performed, of which 229 (2%) underwent revision or repairs.

The majority of ANCOs were encountered in Caucasian patients of Non-Hispanic ethnicity (Table 1), which was reflective of the local population, which is approximately 78% Caucasian and 73% Non-Hispanic by census bureau data. In addition, pediatricians (48.5%) were the most common performing provider, and ANCO was most common in patients who had undergone GOMCO clamp circumcision (47.2%). Of note, pediatricians are the most consulted initial provider in our hospital system to perform newborn circumcisions.

The overall complication rate was 2%. Types of complications encountered are detailed in Table 1. Fifty patients were treated for skin bridges.

Conclusion: Our 1st hand data shows a 2% rate of ANCO as repairs of adhesions / skin bridge formation, incomplete circumcision and buried penis following GOMCO clamp circumcision. From these data, we have planned the following steps as part of a standardized education curriculum: (1) teach parents to perform at home skin care to prevent adhesions and skin bridge formation, (2) standardize incision site marking based on penile anatomic landmarks to assure complete excision of foreskin, and (3) picture-based teaching to guide practitioners on how to identify cases not suited for routine neonatal circumcision.