新生儿诊室包皮环切术与手术包皮环切术的临床和环境考虑因素比较

Benjamin Press, Michael Jalfon, Daniel Solomon, Adam B. Hittelman
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引用次数: 0

摘要

在美国,新生儿男性包皮环切术是一种常见的手术。出于宗教、文化、个人和医学等多种原因,不同年龄段的临床医疗人员都会实施包皮环切术。在美国,新生儿包皮环切术通常由非泌尿科医护人员在婴儿出生后几天内在医院进行,或在婴儿出生后第 8 天作为宗教仪式进行。如果新生儿包皮环切术在医院被推迟,随后又没有在门诊环境中进行,那么通常会在出生 6 个月后在手术室进行全身麻醉。新生儿包皮环切术得到了美国儿科学会(AAP)和美国妇产科医师学会(ACOG)的支持,因为他们认为包皮环切术对健康的益处超过了手术的最低风险。尽管如此,近几十年来,美国新生儿包皮环切手术率有所下降,部分原因是手术的可及性,这通常与保险范围的变化有关。这导致了包皮环切手术率的上升。与新生儿包皮环切术相比,手术性包皮环切术对医疗保健系统的成本更高,病人会受到全身麻醉的心肺毒性和潜在神经毒性的影响,对环境的影响也更大。本文的目的并不是提倡或证明所有患者进行包皮环切术的合理性,而是比较新生儿包皮环切术与手术包皮环切术对临床和环境的影响。
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Clinical and environmental considerations for neonatal, office-based circumcisions compared with operative circumcisions
Neonatal male circumcision is a commonly performed procedure in the United States. Circumcisions are performed at various ages by a variety of clinical providers for multiple reasons, including religious, cultural, personal, and medical indications. In the United States, neonatal circumcision is routinely performed by non-urologic providers in the hospital within the first few days of life or as a religious ceremony on the 8th day of life. If neonatal circumcision is deferred in the hospital and subsequently not performed in the outpatient setting, it is then typically performed in the operating room under general anesthesia after 6 months of life. Neonatal circumcision is supported by both the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) due to the belief that the health benefits outweigh the minimal risk of the procedure. Despite this, neonatal circumcision rates have decreased in the United States in recent decades, in part due to access to the procedure, often related to changing insurance coverage. This has led to increased rates of operative circumcisions. Operative circumcisions are more costly to the healthcare system, subject the patient to cardiopulmonary and potentially neurotoxic effects of general anesthesia, and carry an increased environmental footprint, compared to neonatal circumcision. The intention of this paper is not to promote or justify circumcision for all patients, but rather to compare the clinical and environmental impact of neonatal versus operative circumcisions.
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