What’s the true price of delayed circumcision?

Circumcision beyond the neonatal period can carry higher costs, monetary and otherwise, than neonatal procedures, new research shows.

The study estimated neonatal (aged up to 1 month) and postneonatal (aged 1 month to 1 year) circumcision rates, based on analysis of claims data from commercial health insurance plans, for procedures performed on boys aged from birth to 18 years in 2010. Researchers also estimated the percentage of circumcisions by age and the mean payment for neonatal and postnatal procedures.

Of 156,247 circumcisions performed in the first year of life, 93.6% were in neonates and 6.4% in postneonates. The neonatal circumcision rate was 65.7%; 6.1% of babies who weren’t circumcised as neonates were circumcised by 1 year of age. Of postnatal procedures, 46.6% were performed on boys aged younger than 1 year, 25.1% of them for nonmedical reasons. The mean payment for neonatal circumcision was $285; the mean payment for a postnatal procedure was $1885.

Delaying circumcision beyond the neonatal period increases the risk and cost of the procedure, the researchers observe. Postneonatal circumcision is more expensive because it requires general anesthesia, which also poses extra risks for the child. Later circumcision for nonmedical reasons is associated with more complications, and it delays the protection from urinary tract infections that circumcision confers. Urinary infections are most common in the first year of life.

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The large number of postneonatal circumcisions for nonmedical indications in the study population implies that the procedures could have been done during the neonatal period, representing a missed opportunity, the researchers note. They suggest that discussing circumcision with parents early in the pregnancy could help them make an informed decision and help decrease the number of postneonatal procedures.

The American Academy of Pediatrics says that the health benefits of circumcision for male newborns are sufficient enough to justify the procedure. However, says its policy statement on circumcision, “Parents ultimately should decide whether circumcision is in the best interests of their male child.”

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