Seasonal Variation in Surgical Outcomes as Measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP)

Englesbe, Michael J.; Pelletier, Shawn J.; Magee, John C.; Gauger, Paul G.; Schifftner, Tracy L.; Henderson, William G.; Khuri, Shukri F.; Campbell, Darrell A.

doi:10.1097/sla.0b013e31814855f2

Cited by 171 publications

(110 citation statements)

References 32 publications

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“…22 There are also data from medical as well as other surgical specialties-some of which have been extracted from NSQIP-in which investigators found higher mortality rates in July. 2,3,5,6,18 Although our results do not agree with those of studies focusing on other specialties, our results are consistent with the findings of most other studies that have sought to determine whether a July Effect exists in the practice of neurosurgery. 4,14,15,20 These findings notwithstanding, in our clinical experience we have observed that the July transition period is fraught with clinical challenges.…”

Section: Discussionsupporting

confidence: 78%

“…Large studies in other surgical specialties have demonstrated an increase in adverse outcomes in the late summer, suggesting an association between this transition period and poorer patient care. 2,6,9,11,16,19 The data are conflicting, however, because other studies have not found evidence for this phenomenon. 22 Despite great interest in the subject, there has been limited investigation of the July Effect in the field of neurosurgery.…”

mentioning

confidence: 44%

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Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

Lieber

Appelboom²,

Taylor³

et al. 2016

JNS

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obJective Each July, 4th-year medical students become 1st-year resident physicians and have much greater responsibility in making management decisions. In addition, incumbent residents and fellows advance to their next postgraduate year and face greater challenges. It has been suggested that among patients who have resident physicians as members of their neurosurgical team, this transition may be associated with increased rates of morbidity and mortality, a phenomenon known as the "July Effect." In this study, the authors compared morbidity and mortality rates between the initial and later months of the academic year to determine whether there is truly a July Effect that has an impact on this patient population. methods The authors compared 30-day postoperative outcomes of neurosurgery performed by surgical teams that included resident physicians in training during the first academic quarter (Q1, July through September) with outcomes of neurosurgery performed with resident participation during the final academic quarter (Q4, April through June), using 2006-2012 data from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Regression analyses were performed on outcome data that included mortality, surgical complications, and medical complications, which were graded as mild or severe. To determine whether a July Effect was present in subgroups, secondary analyses were performed to analyze the association of outcomes with each major neurosurgical subspecialty, the postgraduate year of the operating resident, and the academic quarter during which the surgery was performed. To control for possible seasonal trends in certain diseases, the authors compared patient outcomes at academic medical centers to those at community-based hospitals, where procedures were not performed by residents. In addition, the efficiency of academic centers was compared to that of community centers in terms of operative duration and total length of hospital stay. results Overall, there were no statistically significant differences in mortality, morbidity, or efficiency between the earlier and later quarters of the academic year, a finding that also held true among neurosurgical subspecialties and among postgraduate levels of training. There was, however, a slight increase in intraoperative transfusions associated with the transitional period in July (6.41% of procedures in Q4 compared to 7.99% in Q1 of the prior calendar year; p = 0.0005), which primarily occurred in cases involving junior (2nd- to 4th-year) residents. In addition, there was an increased rate of reoperation (1.73% in Q4 to 2.19% in Q1; p < 0.0001) observed mainly among senior (5th- to 7th-year) residents in the early academic months and not paralleled in our community cohort. coNclusioNs There is minimal evidence for a significant July Effect in adult neurosurgery. Our results suggest that, overall, the current resident training system provides enough guidance and support during this challenging transit...

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Section: Discussionsupporting

confidence: 78%

mentioning

confidence: 44%

Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

Lieber

Appelboom²,

Taylor³

et al. 2016

JNS

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“…An observational cohort study analyzing data from the American College of Surgeons-National Surgical Quality Improvement Program database (ACS-NSQIP) database on overall surgeries noted an 18% increase in post-operative morbidity in the July 1 to August 30 cohort (n=9,941) when compared to the April 15 to June 15 cohort (n=10,313) (P=0.0005). A 41% increase in mortality between patient populations depending on the time of year was also noted (P=0.005) (10). The etiologies for this seasonal variation in outcomes have been attributable to both changes in weather patterns and changes in house-staff.…”

Section: Introductionmentioning

confidence: 90%

Associations between seasonal variation and post-operative complications after total hip arthroplasty

Ng¹,

Song²,

George³

et al. 2017

Ann. Transl. Med.

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Background: Total hip arthroplasty (THA) complication rates are low, but pose marked challenges during the post-operative care period. Therefore, it is important to determine which risk factors are associated with an increased rate of these complications. The purpose of this paper was to investigate the association between seasonal variations and the 30-day post-operative complication rates following THA. Specifically, we evaluated a large prospectively collected national database for: (I) overall complication rates; (II) seasonal variations in incidence; and (III) specific quarter (Q), if any, associations. Results: The overall complication rate in this cohort was 1.09%. Upon tabulation of the different post-operative THA complication incidence rates sorted by quarters, 16 out of 20 outcomes had <1% incidence rate, 3 had between a 1% and 5% incidence rate, and 1 outcome had a complication rate greater than 5% (bleeding transfusion). There were no statistical differences in 19 of the 20 complication rates when compared between the different quarters. Transfusion was the only complication with a statistically significant difference (P value <0.001) between the different quarters, which demonstrated a marked increase in Q3/Q4 (July to December), when compared to Q1 (January to March) (P<0.001).Conclusions: Overall, our results indicate a low complication rate in this cohort of patients who underwent a THA (1.09%). There was no correlation between seasonal variation and 30-day complication rates following THA, except for bleeding risk, which remains unexplained. These findings suggest that elective THA does not have to be scheduled around specific times of the year in order to avoid 30-day postoperative complications.

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“…Although there is some evidence in favour of this hypothesis, [3][4][5][6] most studies, including those from medical, 7-9 surgical, 10-14 trauma [15][16][17] and obstetric fields, 18 have not demonstrated the presence of the July effect. However, several of these studies were limited by their single-centre nature and their focus on a single patient group.…”

mentioning

confidence: 99%

Is there any evidence of a “July effect” in patients undergoing major cancer surgery?

Ravi¹,

Trinh

Sun

et al. 2014

cjs

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Seasonal Variation in Surgical Outcomes as Measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP)

Abstract: Our data suggests higher rates of postsurgical morbidity and mortality related to the time of the year. Further study is needed to fully describe the etiologies of the seasonal variation in outcomes.

Cited by 171 publications

References 32 publications

Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

Associations between seasonal variation and post-operative complications after total hip arthroplasty

Is there any evidence of a “July effect” in patients undergoing major cancer surgery?

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