C-20 | Higher Amputation Rates Among Patients Admitted to United States Teaching Hospitals in the Month of July: The July Effect

Abstract

Every year, teaching hospitals in the United States experience a turnover in trainees. Several studies have shown an increase in adverse outcomes and higher resource utilization during the beginning of academic year compared to end academic year. We hypothesized that patient hospitalizations during the month of July would have poorer outcomes compared to those in May. National Inpatient Sample 2018 was queried with ICD-10-CM codes to identify patient admissions during the months of July and May. Outcomes of interest including inpatient mortality, amputation rates and mean length of stay (LOS) were compared between the two groups. A multivariate logistic regression analysis was performed while adjusting for confounders to analyze our outcomes of interest and calculate adjusted odds ratio (aOR) with corresponding 95% confidence interval (CI). A total of 5,560 weighted hospitalizations during the months of July (48.1%) and May (51.9%) were identified. Average age was 70 years and 37.8% were females. Hospital admissions during the month of July were associated with higher amputation rates (aOR 1.33; 1.01 - 1.75, p=0.04), particularly major amputations (aOR 1.50; 1.08-2.1, p=0.02) compared to those in May. There was a non-statistically significant trend towards a higher mean LOS (+0.77 days; -0.58 - 1.59, p=0.07) with July admissions. No difference was found in inpatient mortality rates between the two groups. Hospital admissions during the month of July were associated with higher amputation rates compared to admissions in May. No such July effect was observed in terms of mortality.