Is the "July Effect" real?: an appraisal of teaching surgical services at an academic medical center.
Shakti Nochur MD; Dmitry Nepomnayshy MD, MSc, FACS Lahey Hospital and Medical Center, Burlington, MA, USA
Background:
It has been hypothesized that the rate of post-surgical complications at teaching hospitals are higher in the beginning of the academic year (July-August) when trainees are less experienced. This phenomenon has been termed the "July Effect." We set out to review postoperative complication rates at a tertiary academic medical center to determine if there is a correlation between the beginning of the academic year and higher complication rates.
Methods:
Retrospective review of ten years (2008-2018) of NSQIP-collected postoperative outcomes at a single tertiary care teaching hospital. Cases spanned multiple teaching surgical subspecialties. 30-day postoperative outcomes were studied, including incidence of individual complications, 30-day readmission rate, unplanned return to OR, and median LOS. Data from July was compared against all other months using ARIMA (Autoregressive Integrated Moving Average). The data was then separated by quartile (Q1 - Jan-Mar, Q2 - Apr-Jun, Q3 - Jul-Sep, Q4 - Oct-Dec); complication rates across quartiles were compared using Friedman test.
Results:
There was no statistically significant difference between incidence of any postsurgical complication, median LOS, 30-day readmission rate, or unplanned return to OR in July compared the other months of the academic year. There was a statistically significant increase in organ/space surgical site infections in Q1 and Q3 compared to Q2 and Q4 (p value 0.02). No other postoperative outcome was statistically significantly different between the quartiles.
Conclusion:
There is no evidence of the "July Effect" in postsurgical outcomes when looking at teaching services at a single academic medical center over a 10 year period.
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