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Reducing Complications from Community NonTherapeutic Infant Male Circumcision Through the Introduction of a Quality Assurance Process

Background: It is estimated that there are over 3,000 infant male circumcisions performed in the community in the Greater Manchester area each year. The present study evaluated the effectiveness of a quality assurance process for community providers of infant male circumcision performed in Greater Manchester, England in reducing complications.

Study design: Comparison of hospital admissions data before and after the introduction of the quality assurance process, and comparison of provider compliance with quality assurance standards in 2011 and 2017.

Methods: Records were retrieved for all males less than 12 months of age admitted to the region’s main children’s hospital in 2009 and 2016 (1 Jan - 31Dec) following complications from circumcision. Compliance with quality standards was assessed by a multi-disciplinary panel annually.

Results: 27 male infants were admitted with complications from non-therapeutic circumcision in 2009, and 13 in 2016. Total number of bed days was 38 in 2009 and 25 in 2016. Bleeding occurred in 21 cases in 2009 (78%) and 12 in 2016 (92%). Infection was identified in four cases in 2009 (15%) and one in 2016 (8%). There was no significant difference in the distribution of complications between the two years (p=0.57). Median haemoglobin levels were significantly greater in 2016 compared to 2009 (9.85 g/dL vs 13.05 g/dL, p=0.01). In 2011, nine providers applied for quality assurance and four met the required standards. In 2017, eight providers applied for quality assurance and seven met the required standards.

Conclusions: The introduction of a voluntary quality assurance process was associated with improved compliance with standards of care and a reduced number of admissions to hospital for complications from infant male circumcision.


Paula Jane Whittaker

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