title: Readmission characteristics of elective pediatric circumcisions using large-scale administrative data.
abstract: BACKGROUND
  Elective circumcision is a common procedure, known to be safe and associated with minimal morbidity. There are few data reporting the rates of readmission and reoperation following elective circumcision.
  
  
  OBJECTIVE
  We sought to define the rates of readmission and reoperation in the first 7 days following circumcision to accurately counsel families about the risks of this elective procedure.
  
  
  METHODS
  The Pediatric Health Information System (PHIS) was interrogated from 2004 to 2013 for all ambulatory, elective circumcisions (ICD-9 CM code of 640). We assessed readmission with respect to age, insurance status, race, readmission diagnosis, time to readmission, and seasonal differences (due to higher rates of all-cause hospital admissions). We performed logistical regression analysis with a dependent variable of readmission within 7 days and independent variables of age, race, month of admission, and insurance status.
  
  
  RESULTS
  We identified 95,046 circumcisions from 2004 to 2013 performed in ambulatory surgery centers. Of those, 2906 (3.1%) of patients had an additional encounter at the same facility within 7 days. A total of 2409 (2.4%) of encounters were ER visits, and 253 (0.3%) were encounters for hospital admission or observation. One hundred and thirty-two patients (0.1%) underwent a second ambulatory procedure within the first 7 days following circumcision. Black patients (OR 1.26, p < 0.001) and patients on Medicaid (OR 1.63, p < 0.001) were more likely to seek care of any kind at the same institution within 7 days of the original circumcision operation. No difference was found with regard to time of year on logistic regression. Older age at circumcision was associated with increased likelihood of reoperation compared to children <1 year, with children 12-18 years old having an OR of 1.91 (p = 0.033).
  
  
  CONCLUSIONS
  We present a descriptive study of clinical events occurring at the same tertiary children's hospital within the first 7 days following more than 95,000 elective postneonatal circumcisions. Limitations include a cohort generated from a single set of ICD-9 codes, and a follow-up of 7 days.
  
  
  CONCLUSIONS
  Elective circumcision remains a safe procedure with a readmission rate of 0.3%, and a reoperative rate of 0.1%. However, a relatively high percentage of patients (3.1%) will have a secondary encounter within the first 7 days following circumcision, most of them seeking care in an ER, although not necessarily for circumcision-related reasons. These may be useful data when counseling patients.
authors.affiliation: Department of Urology, Section of Pediatric Urology, Riley Hospital for Children at IU Health, 702 Barnhill Drive, Suite 4230, Indianapolis, IN 46202, USA. Electronic address: joshuarothmd@gmail.com.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Roth
authors.affiliation: Department of Urology, Section of Pediatric Urology, Riley Hospital for Children at IU Health, 702 Barnhill Drive, Suite 4230, Indianapolis, IN 46202, USA.
authors.forename: Alison C
authors.initials: AC
authors.lastname: Keenan
authors.affiliation: Department of Pediatrics, Section of Pediatric and Adolescent Comparative Effectiveness Research, Riley Hospital for Children at IU Health, 702 Barnhill Drive, Suite 4210, Indianapolis, IN 46202, USA.
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Carroll
authors.affiliation: Department of Urology, Section of Pediatric Urology, Riley Hospital for Children at IU Health, 702 Barnhill Drive, Suite 4230, Indianapolis, IN 46202, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Rink
authors.affiliation: Department of Urology, Section of Pediatric Urology, Riley Hospital for Children at IU Health, 702 Barnhill Drive, Suite 4230, Indianapolis, IN 46202, USA.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Cain
authors.affiliation: Department of Urology, Section of Pediatric Urology, Riley Hospital for Children at IU Health, 702 Barnhill Drive, Suite 4230, Indianapolis, IN 46202, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Whittam
authors.affiliation: Department of Pediatrics, Section of Pediatric and Adolescent Comparative Effectiveness Research, Riley Hospital for Children at IU Health, 702 Barnhill Drive, Suite 4210, Indianapolis, IN 46202, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Bennett
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000379:methods*; D017558:Elective Surgical Procedures; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010359:Patient Readmission / Q000639:trends*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014481:United States
keywords: Complications; Post-neonatal circumcision; Readmission; Reoperation