Penile SurgeryMale Circumcision Complications – A Systematic Review, Meta-Analysis and Meta-Regression
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BACKGROUND
Male circumcision is one of the oldest and most common surgical procedures with an estimated global prevalence of 30% among adult males. It is performed due to medical, health preventive, cultural, social, and religious reasons.1 Like all surgery, circumcision is a procedure with risks of complications. There is no consensus regarding the magnitude of circumcision complications, but a number of risk factors such as higher age at circumcision have been suggested.2,3 Due to multiple reasons for
METHODS
We registered a protocol including outcomes, explorative variables and methods before performing searches and analyses (www.crd.york.ac.uk/prospero, ID CRD42020116770). We performed systematic searches in online databases MEDLINE, EMBASE and CENTRAL using index terms (MeSH) and keywords. The search string was “(Circumcision, Male"[Mesh] OR circumcision) AND ("Postoperative Complications"[Mesh] OR complication* OR adverse) AND (boy* or male* or men or infant* or neonat* or newborn* or routine)”.
RESULTS
Electronic database searches yielded 4138 records after duplicates were removed. We included 331 studies according to eligibility criteria and identified 20 additional studies through hand searches. A total of 351 studies were included (Fig. 1) which contributed 469 unique study entries. Non full-text publications contributed 43 entries. Zero outcome events were reported in 76 entries. For characteristics of included studies and references see Supplementary Table 2. Studies reporting primary
DISCUSSION
We performed random-effects meta-analysis to determine risks of post-surgery complications and found about four complications per hundred circumcisions. We also performed mixed-effects metaregression analyses and found circumcision complications to be determined by therapeutic indication, age “child” at circumcision, and South American continent in both complete data and sensitivity analyses. General anesthesia, a study population consisting of private clinic, and European continent also
CONCLUSIONS
Studies of circumcision complications are heterogeneous regarding to the participant, type of circumcision, and study design. Risk of complications was about four per hundred circumcisions across studies and was mainly determined by the participant and the study design. Higher risk of complications was determined by therapeutic circumcisions and age 2-18 years at circumcision as compared to infants. Few of the explored type of circumcision variables seemed associated with complications such as
Acknowledgments
We would like to thank Igor Petrov, MD and Karin Mønsted Shabanzadeh for language assistance.
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Declarations of Interest: None to report.
Financial disclosures: None to report.