Trends in pediatric circumcision in the Brussels University Hospital
The study of the trends in pediatric circumcision in the Brussels University Hospital is a retrospective study in which data are extracted from the Electronic Medical Dossier of the Brussels University Hospital. This database was not entirely complete. Mainly older files were missing and sometimes the indication to circumcise was not noted. The absolute yearly number of each indication of the patients with a lost files or no clear indication was estimated in function of the percentage of the indications in that according year. Thus, the indications are not fully accurate.
1.89 % of the patients who had a code of circumcision were not circumcised and are false positive. The number of circumcisions of patiens with a lost file were corrected accordingly. It is possible that there are also false negative cases ; patient that are not listed under the circumcision code, but were circumcised. This percentage was not assessed and the number of circumcisions was not adjusted accordingly.
Medical files were made by different doctors with a different definition for phimosis. A phimosis, adherent prepuce and tight foreskin are all noted under the ‘phimosis’ code, bearing in mind that some of the patients have a pathologic phimosis and others have a healthy but non-retractile foreskin. It was not possible to distinguish these 3 conditions.
The indications to circumcise were acquired by analyzing the medical files. It is possible that some of the indications to circumcise were misinterpreted, as sometimes the indication was not clearly noted.
Some of the municipalities that are included in the catchment area of the Brussels University Hospital are in fact not part of the actual catchment area. This is due to an overestimation of the number of persons admitted in the Brussels University Hospital. The number of admissions in the Brussels University Hospital was based on anonymous data; only the municipality of the admitted person was noted. Therefore, a person who was admitted twice in an according year was accounted as 2 persons. But the number of pediatric circumcisions performed in the Brussels University Hospital was not compared with the number of boys aged between 0 and 15 years in each municipality of the catchment area, as there were not enough data to do so. This number was compared with the number of boys aged between 0 and 15 years in the Brussels Capital Region and Flemish Brabant and in these regions there are other municipalities that are also not part of the catchment area. This is obviously an overestimation of the catchment population, but the number of boys aged 0 to 15 years old is not important. The trend of this number over time is and this trend in the Brussels Capital Region and Flemish Brabant can be considered comparable with the trend in the municipalities.
In 2005 there is a drop in the number of circumcisions performed in the Brussels University Hospital. This decrease cannot be explained, which indicates that the data of the Brussels University Hospital depend on unknown variables and a change in these factors can have a substantial effect on the figures.
The indications to circumcise were found in the medical reports and entered in a file. Data input always contains errors. The data of the years 1996, 2000, 2006 and 2011 were double-checked and no discrepancy was found.
The data from this study are hospital-based and therefore exclude a proportion of procedures. Jews are traditionally circumcised at the 8th day of life. Neonatal circumcisions are not performed in the Brussels University Hospital. Circumcisions in the Jewish community are mainly done by a specially trained mohel of traditional circumciser in a ceremony called a Bris Milah. Therefore circumcisions of Jewish boys are not included in the study.