Table 1.
Counts, incidence rates, incidence risk ratio, and incidence rate difference of adverse events between circumcised and uncircumcised newborn males. Charge Data Master 1 (CDM1), CDM2, and outpatient data, Unites States 2001 – 2010
| Adverse eventsa (Italicized = Potentially serious; Underlined = probably associated with male circumcision) |
Count among uncircumcised newborns (Incidence per million uncircumcised newborn; 95% CI) N = 1,032,948 |
Count among circumcised newborns (Incidence per million circumcised newborn; 95% CI) N = 1,306,812 |
P value | Incidence Risk Ratio (95% CI) |
Incidence Rate Difference (95% CI) |
|---|---|---|---|---|---|
| Amputationsb | 4 (3.87; 1.45 – 10.31) | 3 (2.29; 0.74 – 7.11) | 0.5 | 0.59 (0.13 – 2.64) | −1.58(−6.18 – 3.02) |
| Amputation of penisb | 4 (3.87; 1.45 – 10.31) | 0 (0) | N.A. | N.A. | N.A. |
| Amputation of penis, partialb | 0 (0) | 3 (2.29; 0.74 – 7.11) | N.A. | N.A. | 3 (2.29; 0.74 – 7.11) |
| Woundsb | 32 (30.97; 21.90 – 43.80) | 89 (68.10; 55.32 – 83.83) | <0.001 | 2.19 (1.46 – 3.29) | 37.12(19.37 – 54.88) |
| Open wound of penis without mention of complicationb | 29 (28.07; 19.51 – 40.40) | 83 (63.51; 51.21 – 78.75) | <0.001 | 2.26 (1.48 – 3.45) | 35.44(18.38 – 52.50) |
| Open wound of penis, complicatedb | 3 (2.90; 0.93 – 9.00) | 6 (4.59; 2.06 – 10.21) | 0.5 | 1.58 (0.39 – 6.32) | 1.68(−3.24 – 6.62) |
| Correctional procedurese | 644 (623.45; 577.13 – 673.50) | 3281 (2510.69; 2426.33 – 2597.97) | <0.001 | 4.02 (3.70 – 4.38) | 1887.23(1778.85 – 1985.62) |
| Suture of laceration of penisb | 43 (41.62; 30.87 – 56.12) | 293 (224.21; 199.95 – 251.40) | <0.001 | 5.38 (3.91 – 7.41) | 182.58(154.06 – 211.11) |
| Suture of laceration of penise | 55 (53.24; 40.88 – 69.35) | 299 (228.80; 204.28 – 256.25) | <0.001 | 4.29 (3.22 – 5.72) | 175.56(146.05 – 205.06) |
| Reconstruction of penisd | 64 (61.95; 48.49 – 79.15) | 15 (11.47; 6.91 – 19.03) | <0.001 | 0.18 (0.10 – 0.32) | −50.48(−66.03 – −34.23) |
| Reconstruction of penise | 77 (74.54; 59.62 – 93.19) | 30 (22.95; 16.05 – 32.83) | <0.001 | 0.30 (0.20 – 0.46) | −51.59(−70.15 – −23.02) |
| Replantation of penisb | 0 (0) | 4 (3.06; 1.14 – 8.15) | N.A. | ||
| Replantation of penise | 1 (0.96; −0.13 – 6.87) | 4 (3.06; 1.14 – 8.15) | 0.3 | 3.16 (0.35 – 28.28) | 2.09(−1.46 – 5.64) |
| Other repairs of penisd | 181 (175.22; 151.47 – 202.70) | 354 (270.88; 244.09 – 300.62) | <0.001 | 1.54 (1.29 – 1.84) | 95.66(57.61 – 133.71) |
| Other repairs of penise | 277 (268.16; 238.37 – 301.67) | 715 (547.13; 508.47 – 588.73) | <0.001 | 2.04 (1.77 – 2.34) | 278.97(227.93 – 330.00) |
| Division of penile adhesionse | 234 (226.53; 199.29 – 257.49) | 557 (426.22; 392.26 – 463.12) | <0.001 | 1.88 (1.61 – 2.19) | 199.69(153.92 – 245.66) |
| Lysis or excision of penile post-circumcision adhesionse | 0 (0) | 757 (579.27; 539.45 – 622.02) | N.A. | N.A. | 757 (579.27; 539.45 – 622.02) |
| Repair incomplete circumcisione | 0 (0) | 919 (703.23; 659.22 – 750.18) | N.A. | N.A. | 919 (703.23; 659.22 – 750.18) |
| Surgical procedurese | 224 (216.85; 190.24 – 247.19) | 52 (39.79; 30.32 – 52.21) | <0.001 | 0.18 (0.13 – 0.240 | −177.06(−207.65 – −146.68) |
| Incision of penisb | 186 (180.06; 155.96 – 207.89) | 21 (16.07; 10.47 – 24.64) | <0.001 | 0.08 (0.05 – 0.14) | −163.99(−190.77 – −137.22) |
| Incision of penise | 202 (195.55; 170.36 – 224.46) | 35 (26.78; 19.22 – 37.30) | <0.001 | 0.13 (0.09 – 0.19) | −168.77(−197.16 – −140.39) |
| Other operations on penise | 22 (21.29; 14.02 – 32.34) | 17 (13.00; 8.08 – 20.92) | 0.1 | 0.61 (0.32 – 1.15) | −8.29(−19.13 – 2.54) |
| Disordersb | 1062 (1028.12; 968.14 – 1091.82) | 799 (611.41; 570.46 – 655.29) | <0.001 | 0.59 (0.54 – 0.65) | −416.71(−491.65 – −341.77) |
| Vascular disorders of penisb | 11 (10.64; 5.89 – 19.22) | 70 (53.56; 42.37 – 67.70) | <0.001 | 5.03 (2.66 – 9.49) | 42.92(28.88 – 56.95) |
| Other specified disorders of penisb | 934 (904.20; 849.06 – 964.06) | 638 (488.21; 451.76 – 527.59) | <0.001 | 0.59 (0.53 – 0.65) | −415.99(−485.24 – −346.76) |
| Unspecified disorders of penisb | 87 (84.224; 68.26 – 103.91) | 78 (59.68; 47.80 – 74.51) | 0.02 | 0.70 (0.52 – 0.96) | −24.54(−46.64 – 2.43) |
| Gangrene, death and decay of body tissue, often occurring in a limb, caused by insufficient blood supply and usually following injury or diseaseb | 30 (29.04; 20.30 – 41.53) | 13 (9.94; 5.77 – 17.13) | 0.001 | 0.34 (0.17 – 0.65) | −19.09(−30.81 – −7.38) |
| Pneumothoraxb | 263 (254.61; 225.62 – 287.31) | 120 (91.82; 76.78 – 109.81) | <0.001 | 0.36 (0.29 – 0.44) | −162.78(−197.66 – −127.91) |
| Spontaneous tension pneumothoraxb | 144 (139.40; 118.40 – 164.13) | 66 (50.50; 39.67 – 64.28) | <0.001 | 0.36 (0.27 – 0.48) | −88.90(−114.73 – −63.08) |
| Iatrogenic pneumothoraxb | 119 (115.20; 96.25 – 137.87) | 54 (41.32; 31.64 – 53.95) | <0.001 | 0.35 (0.26 – 0.49) | −73.88(−97.33 – 50.43) |
| Infectionsb | 842 (815.14; 761.92 – 872.07) | 834 (638.19; 596.33 – 682.99) | <0.001 | 0.78 (0.71 – 0.86) | −176.95(−246.98 – −106.92) |
| Meningitis of unspecified cause: non-pyogenic meningitisb | 2 (1.93; 0.48 – 7.74) | 2 (1.53; 0.38 – 6.11) | 0.99 | 0.79 (0.11 – 5.61) | −0.41(−3.82 – 3.01) |
| Meningitis of unspecified cause: meningitis unspecifiedb | 415 (401.76; 364.91 – 442.32) | 399 (305.32; 276.79 – 336.79) | <0.001 | 0.76 (0.66 – 0.87) | −96.44(−145.34 – −47.54) |
| Methicillin resistant pneumonia due to staphylococcus aureusb | 9 (8.71; 4.53 – 16.74) | 5 (3.82; 1.59 – 9.19) | 0.1 | 0.43 (0.14 – 1.31) | −4.98(−11.49 – 1.72) |
| Cellulites, unspecified siteb | 160 (154.89; 132.66 – 180.85) | 207 (158.40; 138.22 – 181.51) | 0.8 | 1.02 (0.83 – 1.25) | 3.50(−28.77 – 35.78) |
| Bacteremiab | 252 (243.96; 215.62 – 276.01) | 203 (155.34; 135.37 – 178.24) | <0.001 | 0.63 (0.52 – 0.76) | −88.62(−125.55 – −51.69) |
| Staphylococcal scalded skin syndrome/Ritter’s diseaseb | 4 (3.87; 1.45 – 10.31) | 18 (13.77; 8.67 – 21.86) | 0.02 | 3.55 (1.20 – 10.50) | 9.90(2.49 – 17.31) |
| Inflammationsb | 313 (303.01; 271.24 – 338.50) | 616 (471.37; 435.59 – 510.10) | <0.001 | 1.55 (1.35 – 1.78) | 168.36(118.24 – 218.47) |
| Other inflammatory disorders of penis/Cellulites penisb | 42 (40.66; 30.04 – 55.01) | 142 (108.66; 99.21 – 136.35) | <0.001 | 2.67 (1.89 – 3.77) | 68.00(46.31 – 89.69) |
| Edema of penisb | 108 (104.55; 86.58 – 126.25) | 289 (221.14; 197.06 – 248.17) | <0.001 | 2.11 (1.69 – 2.63) | 116.59(84.36 – 148.82) |
| Other inflammatory disorders of male genitalsb | 17 (16.45; 10.23 – 26.47) | 35 (26.78; 19.22 – 37.30) | 0.09 | 1.62 (0.91 – 2.90) | 10.33(−1.0 – 22.15) |
| Edema of male genital organsb | 146 (141.34; 120.18 – 166.23) | 150 (114.78; 97.80 – 134.70) | 0.07 | 0.81 (0.64 – 1.01) | −26.56(−55.94 – 2.82) |
| Stricturesc | 73 (70.67; 56.18 – 88.89) | 104 (79.58; 65.66 – 96.44) | 0.4 | 1.12 (0.83 – 1.51) | 8.91(−13.37 – 31.19) |
| Postoperative urethral stricturec | 1 (0.96; −0.13 – 6.87) | 8 (6.12; 3.06 – 12.24) | 0.08 | 6.32 (0.79 – 50.55) | 5.15(0.51 – 9.80) |
| Urethral stricture, unspecifiedc | 72 (69.70; 55.32 – 87.81) | 95 (72.69; 59.45 – 88.88) | 0.78 | 1.04 (0.76 – 1.41) | 2.99(−18.75 – 24.74) |
| Stricture of male genital organsc | 0 (0) | 1 (0.76; 0.10 – 5.43) | N.A. | 0.76 (0.10 – 5.43) | |
| Bleedingb | 462 (447.26; 408.29 – 489.95) | 1889 (1445.50; 1381.80 – 1512.13) | <0.001 | 3.23 (2.91 – 3.57) | 998.24(921.39 – 1075.09) |
| Unspecified hemorrhage of newbornb | 44 (42.59; 31.69 – 57.23) | 37 (28.31; 20.51 – 39.07) | 0.06 | 0.66 (0.42 – 1.02) | −14.28(−29.82 – 1.26) |
| Intra-operative bleedingb | 350 (338.83; 305.13 – 376.25) | 1614 (1235.06; 1176.29 – 1296.77) | <0.001 | 3.73 (3.31 – 4.19) | 896.23(826.33 – 966.13) |
| Hemorrhage controlb | 26 (25.17; 17.13 – 36.96) | 173 (132.38; 114.05 – 153.65) | <0.001 | 5.25 (3.48 – 7.94) | 107.21(85.24 – 129.18) |
| Suture of arteryb | 0 (0) | 16 (12.24; 7.50 – 19.98) | N.A. | 12.24 (7.50 – 19.98) | |
| Suture of veinb | 32 (30.97; 21.90 – 43.80) | 30 (22.95; 16.05 – 32.83) | 0.2 | 0.74 (0.45 – 1.21) | −8.02(−21.59 – 5.94) |
| Suture of vesselb | 10 (9.68; 5.20 – 17.99) | 19 (14.53; 9.27 – 22.79) | 0.29 | 1.50 (0.69 – 3.22) | 4.86(−4.01 – 13.73) |
a
The total count for a group of adverse events was obtained by adding counts of all individual; potentially serious AE are Italicized
b
Risk window defined for 28 days post-circumcision or post-birth for circumcised males and uncircumcised males respectively
c
Risk window defined for 180 days post-circumcision or post-birth for circumcised males and uncircumcised males respectively
d
Risk window defined for 365 days post-circumcision or post-birth for circumcised males and uncircumcised males respectively
e
Risk window defined for 1200 days post-circumcision or post-birth for circumcised males and uncircumcised males respectively
Note: Adverse events that were not encountered in this analysis, i.e. had a count of zero, were not presented to reduce the length of the table. These are: complete amputation of penis, repair and plastic operation on penis, incision and drainage of penis.
CI: confidence interval
N.A.: not applicable