Debunking the July Effect in Cardiac Surgery: A National Analysis of More Than 470,000 Procedures

Shah, Rohan; Hirji, Sameer; Kiehm, Spencer; Goel, Shivangi; Yazdchi, Farhang; Bellavia, Andrea; Zogg, Cheryl K.; Pelletier, Marc; Shekar, Prem; Kaneko, Tsuyoshi

doi:10.1016/j.athoracsur.2019.06.015

Cited by 12 publications

(15 citation statements)

References 28 publications

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“…Then, after 200 cases, complications are lower than expected. This is contrary to the recent report by Shah and colleagues, 6 who have debunked the ''July effect'' in cardiac surgery and showed that outcomes were similar during the first quartile in teaching hospitals. Another important finding is that residents did improve over time but that few residents crossed the line from greater to lower observed-expected complications.…”

contrasting

confidence: 95%

Commentary: If you don't measure it, you can't improve it

Yanagawa

Ouzounian

Kaneko

2020

The Journal of Thoracic and Cardiovascular Surgery

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contrasting

confidence: 95%

Commentary: If you don't measure it, you can't improve it

Yanagawa

Ouzounian

Kaneko

2020

The Journal of Thoracic and Cardiovascular Surgery

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“…The results of differing studies across different disciplines of medicine have been equivocal. A July effect did not adversely affect the mortality and in-hospital complications rates in patients undergoing cardiac surgeries in in teaching hospitals 1. Patients undergoing adolescent idiopathic scoliosis procedures in July did not have higher rates of intra or postoperative complication when physicians in training were first assistants during the surgery 2.…”

Section: Discussionmentioning

confidence: 89%

“…In this context, it has been postulated that this time period may be associated with higher patient morbidity and mortality given the relative inexperience of the newly starting and transitioning house staff. Studies evaluating a possible July effect in various fields of medicine have found conflicting results 1–5. To date, only one study examined the role of the July effect in the field of anesthesiology affecting clinical care.…”

Section: Introductionmentioning

confidence: 99%

Lack of July effect in the utilization of neuraxial and peripheral nerve block in US teaching hospitals: a retrospective analysis

Kim

Wilson

Liu

et al. 2020

Reg Anesth Pain Med

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BackgroundGiven the steep learning curve for neuraxial and peripheral nerve blocks, utilization of general anesthesia may increase as new house staff begin their residency programs. We sought to determine whether “July effect” affects the utilization of neuraxial anesthesia, peripheral nerve blocks, and opioid prescribing for lower extremity total joint arthroplasties (TJA) in July compared with June in teaching and non-teaching hospitals.MethodsNeuraxial anesthesia, peripheral nerve block use, and opioid prescribing trends were assessed using the Premier database (2006–2016). Analyses were conducted separately for teaching and non-teaching hospitals. Differences in proportions were evaluated via χ2 test, while differences in opioid prescribing were analyzed via Wilcoxon rank-sum tests.ResultsA total of 1 723 256 TJA procedures were identified. The overall proportion of neuraxial anesthesia use in teaching hospitals was 14.4% in both June and July (p=0.940). No significant changes in neuraxial use were seen in non-teaching hospitals (24.5% vs 24.9%; p=0.052). Peripheral nerve block utilization rates did not differ in both teaching (15.4% vs 15.3%; p=0.714) and non-teaching hospitals (10.7% vs 10.5%; p=0.323). Overall median opioid prescribing at teaching hospitals changed modestly from 262.5 oral morphine equivalents (OME) in June to 260 in July (p=0.026) while median opioid prescribing remained at a constant value of 255 OME at non-teaching hospitals (p=0.893).ConclusionUtilization of neuraxial and regional anesthesia techniques was not affected during the initial transition period of new house staff in US teaching institutions. It is feasible that enough resources are available in the system to accommodate periods of turnover and maintain levels of regional anesthetic care including additional attending anesthesiologist oversight.

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“…There is a wealth of data spanning multiple surgical specialties which show that resident involvement does not have a negative impact on patient outcomes when controlled for factors such as baseline patient comorbidities and case complexity. 3 13 14 15 16 On the contrary, some data suggest that residents are associated with a protective effect due to the presence of a second opinion in the perioperative period. 3 16 In cases where both attendings and residents may be adapting to new technology, the second opinion could theoretically prove to be even more significant.…”

Section: Discussionmentioning

confidence: 99%

“… 3 13 14 15 16 On the contrary, some data suggest that residents are associated with a protective effect due to the presence of a second opinion in the perioperative period. 3 16 In cases where both attendings and residents may be adapting to new technology, the second opinion could theoretically prove to be even more significant. While this was not demonstrated in the present study, it is reassuring that no undue harm was imposed upon the patient by having resident involvement.…”

Section: Discussionmentioning

confidence: 99%

Resident involvement in the prostatic urethral lift

Alam

Kohn

Peña

et al. 2021

Asian Journal of Andrology

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Adoption of the prostatic urethral lift (PUL) as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care. This study examines the effect of resident involvement during PUL on patient and procedural outcomes. Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019. Trainees in post-graduate year (PGY) 1–3 are considered junior residents, while those in PGY 4–6 are senior residents. The International Prostate Symptom Score (IPSS) and quality of life (QOL) scores were used to measure outcomes. Simple and mixed-effects linear regression models were used to compare differences. There were 110 patients with a median age of 66.4 years. Residents were involved in 73 cases (66.4%), and senior residents were involved in 31 of those cases. Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired, the percentage of implants successfully placed, or the postoperative catheterization rate. After adjustment for confounding factors, junior residents were associated with significantly longer case length compared to the attending alone (+12.6 min, P = 0.003) but senior residents were not (+2.4 min, P = 0.59). IPSS and QOL scores were not significantly affected by resident involvement ( P = 0.12 and P = 0.21, respectively). The presence of surgeons-in-training, particularly those in the early stages, prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.

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Debunking the July Effect in Cardiac Surgery: A National Analysis of More Than 470,000 Procedures

Cited by 12 publications

References 28 publications

Commentary: If you don't measure it, you can't improve it

Commentary: If you don't measure it, you can't improve it

Lack of July effect in the utilization of neuraxial and peripheral nerve block in US teaching hospitals: a retrospective analysis

Resident involvement in the prostatic urethral lift

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