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Am J Surg. 2008 Nov;196(5):720-5. doi: 10.1016/j.amjsurg.2008.07.005. Epub 2008 Sep 11.

The July effect and cardiac surgery: the effect of the beginning of the academic cycle on outcomes.

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Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.



The effect of the time of the academic year on cardiac surgical outcomes is unknown.


Using prospectively collected data, we identified all (n = 1,673) cardiac surgical procedures performed at our institution between October 1997 and April 2007. Morbidity and mortality rates were compared between 2 periods of the academic year, one early (July 1-August 31, n = 242) and one later in the year (September 1-June 30, n = 1,431). A prediction model was constructed by using stepwise logistic regression modeling.


Morbidity rates did not differ significantly between the early (12.8%) and later periods (15.4%) (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.54-1.28; P = 0.3). Additionally, there was no significant difference in operative mortality between the early (1.2%) and later periods (3.5%) (OR, 0.28; 95% CI, 0.07-1.19; P = 0.06).


The early and later parts of the academic year were associated with similar risk-adjusted outcomes. Further studies are needed to determine whether our findings are applicable to other academic cardiac centers.

[Indexed for MEDLINE]

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