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Can J Surg. 2014 Apr;57(2):82-8.

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

Author information

  • 1The Center for Outcomes Research and Analytics, Vattikuti Urology Institute, Detroit, Mich.
  • 2The Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, University of Montreal, Montréal, Que.
  • 3The Department of Surgery, Division of General Surgery, University of Montreal, Montréal, Que.
  • 4The Department of Urology, Weill Medical College of Cornell University, New York, NY.
  • 5The Department of Urology, Mayo Clinic, Rochester, Minn.
  • 6The Department of Urology, Georgetown University Hospital, Washington, DC.
  • 7The Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Calif.
  • 8The Center for Outcomes Research and Analytics, Vattikuti Urology Institute, Detroit, Mich. and the Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, University of Montreal, Montréal, Que.

Abstract

in English, French

BACKGROUND:

The "July effect" refers to the phenomenon of adverse impacts on patient care arising from the changeover in medical staff that takes place during this month at academic medical centres in North America. There has been some evidence supporting the presence of the July effect, including data from surgical specialties. Uniformity of care, regardless of time of year, is required for patients undergoing major cancer surgery. We therefore sought to perform a population-level assessment for the presence of a July effect in this field.

METHODS:

We used the Nationwide Inpatient Sample to abstract data on patients undergoing 1 of 8 major cancer surgeries at academic medical centres between Jan. 1, 1999, and Dec. 30, 2009. The primary outcomes examined were postoperative complications and in-hospital mortality. Univariate analyses and subsequently multivariate analyses, controlling for patient and hospital characteristics, were performed to identify whether the time of surgery was an independent predictor of outcome after major cancer surgery.

RESULTS:

On univariate analysis, the overall postoperative complication rate, as well as genitourinary and hematologic complications specifically, was higher in July than the rest of the year. However, on multivariate analysis, only hematologic complications were significantly higher in July, with no difference in overall postoperative complication rate or in-hospital mortality for all 8 surgeries considered separately or together.

CONCLUSION:

On the whole, the data confirm an absence of a July effect in patients undergoing major cancer surgery.

PMID:
24666444
[PubMed - indexed for MEDLINE]
PMCID:
PMC3968195
Free PMC Article
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