The July Effect in Urologic Surgery: Myth or Reality?

Abstract

PurposeThe July Effect is the widely held belief that medical care is compromised at the beginning of the academic year due to transitioning medical trainees. We sought to determine its impact on surgical outcomes in urologic surgery. Materials and MethodsThe Healthcare Cost and Utilization Project State Inpatient Database, Ambulatory Surgery and Services Database and Emergency Department Database for California were utilized for years 2007-2011. Patients were identified who underwent surgery in July, August, April and May and separated into early (July and August) and late (April and May) cohorts. Surgical outcomes for early vs. late surgery were compared for academic centers. Adjusted multivariate models were fit to determine the effect of early surgery as a predictor of adverse outcomes. ResultsFor major urologic surgery July/August surgery had no impact on length of stay, 30 day readmission, 30 day emergency room visits, never events, perioperative complications or mortality (all p-values >0.05). Similarly, for stone, groin, bladder outlet and cystoscopic bladder procedures, July/August surgery had no impact on rates of urinary retention, ER visits within 30 days, clot evacuations within 30 days, perioperative complications or 30 day readmissions (all p-values >0.05). At the end of the year, cystectomies had increased odds of intraoperative complications (OR 0.63(CI 0.4-0.97) while nephrectomies had higher odds of major complications (OR 0.69(CI 0.53-0.89). ConclusionsOur study demonstrated that surgical outcomes are not compromised by having surgery at the beginning of the academic year despite resident turnover representing appropriate oversight during this potentially vulnerable time.