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Johnson EK, Hyman MJ, Hardy C, Maizels M, Seager CM, Matoka DJ, Liu DB, Gong EM, Holl JL, Modi PK. Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States. Urology 2024; 184:206-211. [PMID: 37979701 DOI: 10.1016/j.urology.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade. METHODS The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year. Simple linear regression assessed growth in proportion of newborn circumcisions performed by pediatric urologists and APPs (nurse practitioner/physician assistant/midwife), over time. RESULTS In total, 1,006,748 newborn circumcisions (59% inpatient) were identified; while most were performed by obstetricians (45%) or pediatricians (33%); APPs performed 0.9%, and pediatric urologists performed 0.7%. From 2010-2021, the proportion of newborn circumcisions performed by pediatric urologists increased from 0.3% to 2.0% and by APPs in from 0.5% to 2.9% (P < .001 for both). Growth for both pediatric urologists and APPs occurred APPs predominantly from 2016 to 2021. Trends in proportion of newborn circumcision performed by pediatricians was stable [31.5% (2010) and 32.5% (2021)], but decreased for obstetricians [48.8% (2014) and 38.1% (2021)]. CONCLUSION The proportion of newborn circumcisions performed by pediatric urologists and APPs increased more than 6-fold between 2010 and 2021, though both specialties still perform a minority of newborn circumcisions. These data provide important baseline information for newborn circumcision workforce planning, including evaluating collaborative care models where pediatric urologists train APPs to perform circumcision.
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Affiliation(s)
- Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Max J Hyman
- The Center for Health and the Social Sciences, The University of Chicago, Chicago, IL
| | - Camille Hardy
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Max Maizels
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Catherine M Seager
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Derek J Matoka
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL
| | - Parth K Modi
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
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Johnson EK, Rosoklija I, Walton RF, Matoka DJ, Seager CM, Holl JL. Physician Perspectives on Performing Newborn Circumcisions: Barriers and Opportunities. Matern Child Health J 2024; 28:144-154. [PMID: 37919635 DOI: 10.1007/s10995-023-03822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Over half of infant boys born in the United States undergo newborn circumcision. However, available data indicate that boys who are publicly insured, or Black/African American, have less access to desired newborn circumcision, thus concentrating riskier, more costly operative circumcision among these populations. This study ascertains perinatal physician perspectives about barriers and facilitators to providing newborn circumcisions, with a goal of informing future strategies to ensure more equitable access. METHODS Qualitative interviews about newborn circumcision care were conducted from April-June 2020 at eleven Chicago-Area hospitals. Physicians that provide perinatal care (pediatricians, family medicine physicians, and obstetricians) participated in qualitative interviews about newborn circumcision. Inductive and deductive qualitative coding was performed to identify themes related to barriers and facilitators of newborn circumcision care. RESULTS The 23 participating physicians (78% female, 74% white, median 16 years since medical school graduation [range 5-38 years], 52% hospital leadership role, 78% currently perform circumcisions) reported multiple barriers including difficulty with procedural logistics and inconsistent clinician availability and training; corresponding suggestions for operational improvements were also provided. Regarding newborn circumcision insurance coverage and reimbursement, physicians reported limited knowledge, but noted that some insurance reimbursement policies financially disincentivize clinicians and hospitals from offering inpatient newborn circumcision. CONCLUSIONS Physicians identified logistical/operational, and reimbursement-related barriers to providing newborn circumcision for desirous families. Future studies and advocacy work should focus on developing clinical strategies and healthcare policies to ensure equitable access, and incentivize clinicians/hospitals to perform newborn circumcisions.
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Affiliation(s)
- Emilie K Johnson
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA.
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Ilina Rosoklija
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
| | - Ryan F Walton
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
| | - Derek J Matoka
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine M Seager
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL, 60611, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane L Holl
- Division of Biological Sciences, University of Chicago, Chicago, IL, USA
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Hernandez K, Soto S, Ellsworth PI. Reducing costs of referrals for non-neonatal circumcision in Florida Medicaid population. J Pediatr Urol 2023; 19:537.e1-537.e6. [PMID: 37244838 DOI: 10.1016/j.jpurol.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Florida Medicaid will only cover a non-neonatal circumcision if it meets the specified Medicaid medical indications or the patient is 3 years or older and has failed a 6-week trial of topical steroid therapy (TST). Referral of children who do not meet guideline criteria results in unnecessary costs. OBJECTIVE We sought to evaluate the cost savings if the initial evaluation and management were performed by the primary care provider (PCP) with referral to a pediatric urologist of only those males meeting the guidelines. STUDY DESIGN An institutional review board-approved retrospective chart review of all male pediatric patients ≥3 years of age presenting for phimosis/circumcision from September 2016 to September 2019 at our institution was performed. Data extracted included (1) presence of phimosis, (2) presence of medical indication for circumcision on presentation, (3) circumcision performed without meeting criteria, (4) use of topical steroid therapy prior to referral. The population was stratified into 2 groups based on whether criteria were met at the time of referral. Those with a defined medical indication on presentation were excluded from cost analysis. Cost savings were based on costs incurred for PCP visit(s) versus initial referral to a urologist using estimated Medicaid reimbursement rates. RESULTS Of the 763 males, 76.1% (581) did not meet Medicaid criteria for circumcision on presentation. Of these, 67 had a retractable foreskin with no medical indication, 514 had phimosis with no documented topical steroid therapy (TST) failure. A savings of $95,704.16 would have been incurred if the PCP initiated the evaluation and management and referred only those who met the criteria (Table 2). DISCUSSION These savings would only be feasible if there were proper education of PCPs in the evaluation of phimosis and the role of TST. Limitations are assuming cost savings in the setting of well-educated pediatricians for clinical exam and believing they are aware of and comply with the guidelines. CONCLUSIONS Education of PCPs on the role of TST in phimosis and current Medicaid guidelines may reduce unnecessary office visits, health care costs, and family burden. The most impactful method to reduce the cost of non-neonatal circumcision would be for states that do not currently cover neonatal circumcision to acknowledge affirmative policies from the American Academy of Pediatrics regarding circumcision and realize the cost savings associated with providing coverage for neonatal circumcision and reducing significantly the number of more expensive non-neonatal circumcisions.
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Affiliation(s)
- Kailee Hernandez
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Susana Soto
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Pamela I Ellsworth
- Nemours Children's Health Florida, 6535 Nemours Pkwy, Orlando, FL, 32827, USA.
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Kamanzi SN, Walton RF, Rosoklija I, Corona LE, Holl JL, Johnson EK. Differential Insurance Plan Coverage and Surgeon Reimbursement of Pediatric Circumcision at an Urban, Midwestern Hospital. Urology 2023; 179:143-150. [PMID: 37343682 DOI: 10.1016/j.urology.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To explore private vs public pediatric circumcision insurance coverage and surgeon reimbursement. METHODS A telephone survey about circumcision coverage (Current Procedural Terminology codes: 54150, 54161) was conducted in October 2021 with insurance plan representatives from the 12 plans that comprised ≥1% of institutional pediatric urology visits to compare plan characteristics and coverage details. Circumcision billing data were collected at one pediatric hospital to assess surgeon reimbursement (insurance+patient payment) by plan type using bivariate statistics. RESULTS Ten plans (5 private and 5 public) responded (83.3% response rate). All except one public plan covered newborn circumcision. For non-newborn circumcisions, most public plans (80%) had unrestricted coverage, whereas all private plans required medical necessity. Median reimbursement for newborn circumcision (CPT: 54150) was $484 for private and $78 for public plans, P < .001 while median reimbursement for non-newborn circumcision (CPT: 54161) was $314 for private and $147 for public plans, P < .001. CONCLUSION Private insurance plans reimburse significantly more than public plans for newborn circumcision. For non-newborn circumcision, private plans reimburse more than public but the coverage is more restricted, with a smaller differential between newborn and non-newborn circumcision. This coverage and reimbursement structure may indirectly encourage newborn circumcision for privately insured boys and non-newborn circumcision for publicly insured boys.
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Affiliation(s)
- Sophia N Kamanzi
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ryan F Walton
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Lauren E Corona
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jane L Holl
- Department of Neurology, Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Lin CY, Johnson EK, Del Rio CV, Grimsby GM. Lack of Medicaid Coverage of Routine Newborn Circumcision Leads to Increased Operative Circumcisions, Chordee Procedures, and Balanitis. Urology 2023; 179:136-142. [PMID: 37328011 DOI: 10.1016/j.urology.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To compare proportions of newborn circumcisions, operative circumcisions, chordee procedures, and cases of balanitis in states where Medicaid covers newborn circumcision (covered states) versus states that do not (noncovered states) using the pediatric health information system database. METHODS A retrospective review of pediatric health information system data was conducted from 2011 to 2020. The proportions and median ages of newborn circumcision current procedural terminology (CPT 54,150, 54,160), operative circumcision (CPT 54,161), chordee (CPT 54,360), and balanitis (ICD-9 607.1, ICD-10 N48.1, N47.6) were compared in covered versus noncovered states. RESULTS A total of 118,530 circumcisions were reviewed. Covered states had significantly higher proportions of circumcision overall (9.7% vs 7.1%, P < 0.0001). Noncovered states had significantly higher proportions of Medicaid-covered operative circumcisions (54.9% vs 47.7%, P < 0.0001). Compared to covered states, noncovered states had significantly higher median ages of all types of circumcisions. Noncovered states also had higher numbers of balanitis cases and double the incidence of balanitis compared with covered states. The median age of chordee (1.07 vs 0.79 years, P < 0.0001) and proportion of chordee repairs (15.2% vs 12.9%, P < 0.0001) were also significantly higher in noncovered states. CONCLUSION The lack of Medicaid coverage of circumcision increases the number of foreskin procedures done in the operating room. In addition, in states without Medicaid coverage of circumcision, there is an increased burden of disease related to the foreskin. These findings represent a need to further investigate the costs of healthcare associated with Medicaid coverage of circumcision or the lack thereof.
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Affiliation(s)
- Chung Y Lin
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL
| | - Emilie K Johnson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Urology, Chicago, IL; Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL
| | - Carlos V Del Rio
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL; Phoenix Children's Division of Urology, Phoenix, AZ
| | - Gwen M Grimsby
- Northwestern University Feinberg School of Medicine, Department of Urology, Chicago, IL; Phoenix Children's Division of Urology, Phoenix, AZ.
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Skertich NJ, Sullivan GA, Herberg RE, Gulack BC, Beth Madonna M, Pillai S, Shah AN. The effect of inpatient versus outpatient location on postoperative healthcare utilization after neonatal circumcision. J Pediatr Surg 2022; 57:1072-1075. [PMID: 35277248 DOI: 10.1016/j.jpedsurg.2022.01.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Neonatal circumcision is a common pediatric procedure performed in both the inpatient and outpatient setting. We aimed to determine if procedure location affected 30-day post-procedure healthcare utilization rates, inpatient length of stay (LOS), and amount charged. METHODS We performed a retrospective cohort study comparing 30-day postoperative healthcare utilization (emergency department (ED) visits, office visits, readmissions) of full-term infants who underwent an outpatient versus inpatient (same admission as birth) circumcision from 2015 to 2020. Statistical analyses included Chi-square tests, multivariable adjusted logistic regression models when appropriate. RESULTS 3137 infants were included, 1426 (45.5%) had an outpatient circumcision, 1711 (54.5%) an inpatient. Outpatient had similar overall healthcare utilization rates as inpatients (5.7% vs. 5.6%, p = 0.933). The number of ED visits (1.5% vs 0.8%, p = 0.055), office visits (4.5% vs. 5.1%, p = 0.437), and readmissions (0.2% vs. 0.0%, p = 0.058) were not significantly different. Infants with inpatient circumcisions had longer LOS after adjusting for age, ethnicity and delivery type (Cesarean versus vaginal) with an incident rate ratio of 1.97 (95% confidence interval 1.84-2.11, p<0.001). Outpatient circumcision resulted in average charges of $372 more than inpatient. CONCLUSIONS Outpatient circumcision has a minimal effect on healthcare utilization rates but lead to a shorter hospital stay following birth and increased charge. STUDY DESIGN Retrospective LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Nicholas J Skertich
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States.
| | - Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | | | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Mary Beth Madonna
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Srikumar Pillai
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
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Ezomike UO, Chinawa JM, Enebe JT, Ezugwu EC, Aniwada EC, Ezomike NE, Chinawa AT, Ekenze SO. Evaluation of maternal preferences for neonatal male circumcision in Enugu Nigeria. Afr J Paediatr Surg 2022; 19:73-77. [PMID: 35017375 PMCID: PMC8809468 DOI: 10.4103/ajps.ajps_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/27/2021] [Accepted: 08/26/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although circumcision in male neonates is one of the most common procedures performed in neonatal surgery, mothers' preferences concerning the aspects of circumcision are not well-known. Since mother is the likely parent to present child for circumcision, her preferences should be given adequate consideration. OBJECTIVES The objective of this study is to evaluate maternal preferences for neonatal male circumcision in Enugu. METHODOLOGY A cross-sectional study where questionnaire was distributed by the researchers to consenting pregnant women attending antenatal clinics in two teaching hospitals in Enugu. Data analysis was performed using the SPSS. The results presented as means, percentages and tables. Test for significance was done using the Chi-square test. RESULTS Four hundred and sixty-one pregnant women participated in the study. Ninety-five percent (438/461) wanted circumcision and 83.5% (385/461) wanted it on or before the 8th day of life. The reasons were cultural/religious in 69% (302/447). Fifty-four percent (250/461) had no preferences as to methods, but for those who had, Plastibell was most preferred method in 28% (129/461) while 76% (235/309) preferred circumcision to be done in hospital. In 49.2% (227/461) preferred personnel were nurses but 79.6% (367/461) wanted doctors to attend to post-circumcision complications. In 79.2% (365/461), mothers will not insist on the use of anaesthesia for circumcision. Mothers with circumcised husbands were significantly more willing to circumcise a male child (P = 0.0018). Higher educational status of mother was significantly related to willingness to insist on the use of anaesthesia (P = 0.046) and use of analgesics after circumcision (P = 0.001). CONCLUSIONS Most mothers prefer neonatal male circumcision by nurses, while preferring doctors for post-circumcision complications. These choices are not affected by parents' educational status. Mothers with circumcised husbands accepted circumcision more than those with uncircumcised husbands. Higher maternal education encourages anaesthesia during circumcision and post-circumcision analgesia.
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Affiliation(s)
- Uchechukwu Obiora Ezomike
- Sub-Department of Pediatric Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - Josephat Maduabuchi Chinawa
- Department of Pediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - Joseph T. Enebe
- Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Euzebus Chinonye Ezugwu
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - Elias C. Aniwada
- Department of Community Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | | | - Awoere T. Chinawa
- Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Sebastian Okwuchukwu Ekenze
- Sub-Department of Pediatric Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
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Naha U, Arora HC, Walton RF, Rosoklija I, Skibley LM, Johnson EK. Neonatal circumcision availability in the United States: a physician survey. BMC Urol 2021; 21:148. [PMID: 34706684 PMCID: PMC8549161 DOI: 10.1186/s12894-021-00911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
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 across the United States and identify potential reasons contributing to disparities in access. 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%]). Neonatal circumcision was available at 86% of hospitals represented. On univariate and multivariate analysis, the 50 hospitals that did not offer neonatal circumcision 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 neonatal circumcision. 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 neonatal circumcision equitably and comprehensively.
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Affiliation(s)
- Ushasi Naha
- University of Illinois College of Medicine, Chicago, USA
| | - Hans C Arora
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
- Department of Urology, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box 24, Chicago, IL, 60611, USA
| | - Ryan F Walton
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Lindsay M Skibley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
- Department of Urology, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box 24, Chicago, IL, 60611, USA.
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, USA.
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