Bringing Jewish ritual circumcision (Brit Milah) into the operating room: An analysis of surgical outcomes and satisfaction across families and Society of Pediatric Urology members

Abstract Objectives To assess caregiver satisfaction, procedural outcomes and practitioner opinion regarding a novel program designed for patients to undergo a deferred Jewish ritual circumcision (Brit Milah) in the operating room (OR), combined with other indicated surgical procedures. Methods All patients undergoing Brit Milah in the OR at our institution between 2013-2019 were included. Surveys were administered to assess caregiver satisfaction and Society for Pediatric Urology (SPU) member practice patterns. A retrospective case-control series was completed to compare complication rates and operative times for procedures with and without Brit Milah. Results 44 intra-operative Brit Milah patients were identified. The mean procedure time for a distal hypospadias repair with Brit Milah was 66.0 min, compared to 62.4 min without (p=0.57). No complications were attributable to the addition of Brit Milah. The caregiver survey had a 100% response rate. The modal response for satisfaction with the peri-operative experience was 5/5 (i.e. highly satisfied), with 100% of respondents very likely to recommend the program. 132 active SPU members responded to the survey (34.1% response rate) with 44% regularly allowing Brit Milah in the OR at their institution. 90.5% received positive caregiver feedback and 64% believe it is important to offer. Conclusions This novel program incorporating Brit Milah into the OR yields high caregiver satisfaction, no additional OR time or post-operative complications, and provides an opportunity to combine family-centered care with cultural competence.