Postneonatal circumcision with local anesthesia: A cost-effective alternative

Purpose: Despite the controversy regarding the need for routine neonatal ci rcumcision, most boys in the United States are circumcised. Physicians are commonly asked to perform circumcision after the neonatal period and are of ten unaware of the cost factors related to the timing and location of postn eonatal circumcision. Materials and Methods: We describe the medical and financial advantages of postneonatal circumcision with local versus general anesthesia. Results: During a 30-month period 245 boys 6 months to 15 years old underwe nt circumcision under general anesthesia in the operating room. Hospital ch arges (facility and equipment) averaged $1,555 and anesthesia charges avera ged $250. Therefore, the average cost for circumcision in the operating roo m was $1,805. During the same time period 287 infants 3 days to 9 months ol d (20% older than 3 months) underwent circumcision under local anesthesia i n an office setting. The facility and equipment charge for these office pro cedures averaged $196. Overall, approximately $461,783 were saved in this 3 0-month period ($184,713 annually) by performing circumcision with local an esthesia in an office setting rather then in the operating room with genera l anesthesia. There was no significant difference in complication rates bet ween the local and general anesthesia groups (1.4 versus 1.6%). Conclusions: Circumcision with local anesthesia can be performed easily and safely during the first several months of life and has many advantages. Pa rents prefer this method because it is more convenient and eliminates the r isk of general anesthesia. The enormous cost savings using local as opposed to general anesthesia should prompt a reexamination of the location and ti ming of postneonatal circumcision.