Study Examines Risks Of Circumcision

This report, the broadest of its kind, examined all hospital records in the state of Washington for a study period of more than nine years. The study finds there was a complication in one out of every 476 circumcisions.

"Circumcision is a relatively safe procedure. However, for some parents, the risks we report may outweigh the benefits," says Dr. Dimitri Christakis, an assistant professor of pediatrics at the UW School of Medicine and associate director of the UW's Child Health Institute in Seattle. Christakis got the idea for the study from the parents of his patients. He's a pediatrician at UW Medical Center-Roosevelt's Pediatric Care Center in Seattle. Christakis says that many parents already know what they want for their baby boys. But other parents would ask him about the risks and benefits of circumcision.

Benefits of circumcision have been extensively studied, Christakis said. But the risks have been examined with more limited studies.

"Parents ask about this all the time. I was dissatisfied with the evidence available that delineates the risks," Christakis says.

What UW doctors did was pore over Washington state hospital records from 1987 to 1996. Of the 354,297 boys born during the study period, 130,475 had circumcisions in the hospital. The study found that 287 of them had complications related to the procedure. The most common were intraoperative bleeding (230 cases) and damage to the penis that required treatment (52 cases). Those complications required longer hospital stays.

The UW study is a "trade-off analysis." The trade-off analysis determined that for every case of a boy who has a complication from circumcision, six boys can be expected to have avoided urinary tract infections. For every two cases of circumcision complications, one case of penile cancer is prevented.

The study offers a conservative estimate of the actual risks, Christakis says, because it only measured complications during a baby's first hospital stay. For example, doctors know that some children with circumcisions suffer infections. But those usually occur after the birth hospitalization, and were not reflected in the database used in the study.

The trade-off analysis does not attempt to tell parents whether they should have their child circumcised or not. That's because different parents view risks and benefits differently.

For example, some parents may not want to do something that might cause their baby both pain and a complication, even if there is a fractional chance that the circumcision may prevent another problem.

Almost all of the problems arising from either circumcision or its lack ­ urinary tract infections, excessive bleeding and penile wounds -- are easily treated. Penile cancer usually occurs only in the very elderly and can also be prevented with good hygiene.

"We're talking about trade-offs for very rare risks and very rare benefits," Christakis says. "Now, I can tell parents that one in 500 circumcised children may suffer a complication, and one in 100 children may derive a benefit. But people will weigh that differently. However, the vast majority of children will gain no medical benefit nor suffer any complication as a result of circumcision."

Other authors of the study include Dr. Frederick A. Connell from the Department of Health Services in the UW School of Public Health; Dr. Danielle M. Zerr of the School of Medicine's Division of Infectious Disease; Eric Harvey of the Department of Pharmacy; and Dr. Chris Feudtner and Dr. Jeffrey Wright, both of the Department of Pediatrics.