986: Association between surgical complications and early academic period in women undergoing cesarean delivery: July phenomenon

Abstract

Each July in the United States, approximately 1,300 doctors begin training in Obstetrics and Gynecology. Anecdotally, the concern is that the turnover of responsibility at the beginning of the academic year results in an increase in morbidity and mortality associated with surgical procedures. We sought to compare the rates of operative complications between women who delivered in an early academic period compared to those who delivered in a late academic period. We conducted a retrospective cohort study evaluating all women undergoing cesarean delivery at ≥ 23 weeks’ gestation between 2012 and 2017 at an urban teaching hospital with an average of 1,200 cesarean deliveries per year. Women were categorized based on academic period (the early academic period from July to August and the late academic period from September to June). Our primary outcome was defined as a composite of hemorrhage (blood loss ≥1000 mL requiring red blood cell transfusion), bladder injury, bowel injury, and neonatal injury. Surgical duration was also examined. Outcomes were compared between women who delivered in the early academic period and those who delivered in the late academic period. Multivariable logistic regression or linear regression models were performed, controlling for predefined covariates including age, race, gestational age, body mass index (kg/m2), number of previous cesarean delivery, and year of delivery. Trends in rates of the primary outcome were examined by month. Of 7,016 women who underwent cesarean delivery, 1,291 (18.4%) delivered in the early academic cycle. Early academic period compared to late academic period was not associated with increased odds of the primary outcome (4.7% vs. 4.3%; adjusted odds ratio 1.07 [0.80-1.44]), hemorrhage (4.7% vs. 4.1%; adjusted odds ratio 1.12 [0.84-1.50]), bladder injury (0% vs. 0.1%; unadjusted P =.41), bowel injury (0.1% vs. 0.1%; unadjusted P =.73), and neonatal injury (0% vs. 0.1%; unadjusted P=.21), but was associated with 2 minutes longer surgical duration (adjusted P <.001) (Table). There were no trends in rates of the primary outcome throughout the year (P =.29) (Figure). In an urban teaching hospital with a high level of resident involvement, the early academic period was associated with longer surgical duration but was not associated with increased odds of operative complications. Our data reassure physicians and women who undergo cesarean delivery in the early academic period.View Large Image Figure ViewerDownload Hi-res image Download (PPT)