title: Complications following circumcision: Presentations to the emergency department.
abstract: BACKGROUND
  Circumcision is the most common surgical procedure performed on boys in Australia. Patient presentations to the emergency department (ED) following circumcision are common; however, no Australian research has investigated acute care presentations.
  
  
  OBJECTIVE
  To identify reasons for presentation to the ED after circumcision and determine whether the setting (community vs. hospital) in which the procedure had been performed has any bearing on the sequelae seen.
  
  
  METHODS
  Retrospective chart review of children presenting with circumcision related problems to the Royal Children's Hospital, Melbourne, Australia, between 2012 and 2014. Descriptive and χ(2) analysis included sequelae of community- versus hospital-performed procedures.
  
  
  RESULTS
  Over a 29-month period, we identified 167 children with a circumcision-related ED presentation. Mean age was 3 years. A percentage of 54.5 had been performed for non-medical, 29.9% for medical reasons and 14.4% for reasons unknown. When location was known (n = 152), 60.5% were performed in the community and 39.5% in hospital. Reasons for presentation were: bleeding (53.9%), pain (38.3%), swelling (37.1%), redness (25.7%), decreased urine output (13.8%), fever (7.2%) and pus (6%). 29.9% were diagnosed as normal healing post circumcision. Patients were admitted in 39.1% versus 15% (P = 0.001) and re-operated in 18.5% versus 1.7% (P = 0.001) after community- versus hospital-operated circumcisions.
  
  
  CONCLUSIONS
  A range of reasons cause patients to seek help in the ED following a circumcision. Parents would have profited from better explanation of post-circumcision appearance of the penis. ED presentations after community-performed procedures required more re-operations than after hospital-performed circumcisions.
authors.affiliation: Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Grace
authors.initials: G
authors.lastname: Gold
authors.affiliation: Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Paediatric Urology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Young
authors.affiliation: Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.|Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Mike
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Paediatric Urology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000009:adverse effects*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: circumcision; complication; emergency department; haemorrhage; infection