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

doi:10.1503/cjs.002713

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

doi: 10.1503/cjs.002713.

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

Affiliations

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

PMID: 24666444
PMCID: PMC3968195
DOI: 10.1503/cjs.002713

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

Praful Ravi et al. Can J Surg. 2014 Apr.

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

doi: 10.1503/cjs.002713.

Authors

Affiliations

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

PMID: 24666444
PMCID: PMC3968195
DOI: 10.1503/cjs.002713

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.

Contexte: L’effet « juillet » désigne les répercussions négatives que peut avoir sur les soins aux patients le roulement du personnel médical qui survient au cours de ce mois d’été dans les centres médicaux universitaires d’Amérique du Nord. Certaines preuves ont étayé l’existence de l’effet juillet, notamment des données provenant des spéciali tés chirurgicales. Peu importe le temps de l’année, l’uniformité des soins est indispensable pour les patients qui doivent subir des interventions chirurgicales majeures pour le cancer. Nous avons donc voulu effectuer une évaluation à l’échelle des populations au sujet de l’existence d’un effet juillet dans cette branche de la médecine.

Méthodes: Nous avons utilisé la base de données Nationwide Inpatient Sample pour extraire les données relatives aux patients soumis à l’une de 8 interventions chirurgicales majeures pour le cancer dans des centres médicaux universitaires entre le 1er janvier 1999 et le 30 décembre 2009. Les principaux paramètres examinés ont été les complications postopératoires et la mortalité perhospitalière. Nous avons effectué des analyses univariées et, par la suite, des analyses multivariées en tenant compte des caractéristiques des patients et des hôpitaux afin de vérifier si la date à laquelle la chirurgie a eu lieu était un prédicteur indépendant des résultats après une chirurgie majeure pour le cancer.

Résultats: L’analyse univariée a révélé que les taux de complications postopératoires globales et de complications des interventions urogénitales et hématologiques plus spécifiquement ont été plus élevés en juillet qu’à d’autres moments de l’année. Toutefois, à l’analyse multivariée, seules les complications des suites d’interventions pour un cancer hématologique ont été significativement plus élevées en juillet, sans différence au plan du taux de complications postopératoires globales ou du taux de mortalité perhospitalière pour les 8 interventions considérées séparément ou ensemble.

Conclusion: Globalement, les données confirment l’absence d’un effet juillet chez les patients soumis à une intervention chirurgicale majeure pour un cancer.

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Figures

**Fig. 1**
Complication rate and mortality according to date of admission in teaching hospitals from the Nationwide Inpatient Sample, 1999–2009. Average yearly complication and mortality rates were 19.4% and 1.73%, respectively. Univariate χ² test of independence showed significant variations for overall complications (p < 0.001) and for mortality (p = 0.003).

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References

1. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington (DC): National Academy; 2000. - PubMed
1. Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2002–2003. JAMA. 2003;290:1197–202. - PubMed
1. Dasenbrock HH, Clarke MJ, Thompson RE, et al. The impact of July hospital admission on outcome after surgery for spinal metastases at academic medical centers in the United States, 2005 to 2008. Cancer. 2012;118:1429–38. - PubMed
1. Kestle JR, Cochrane DD, Drake JM. Shunt insertion in the summer: Is it safe? J Neurosurg. 2006;105:165–8. - PubMed
1. Englesbe MJ, Pelletier SJ, Magee JC, et al. Seasonal variation in surgical outcomes as measured by the American College of Surgeons —National Surgical Quality Improvement Program (ACS-NSQIP) Ann Surg. 2007;246:456–62. discussion 463–5. - PMC - PubMed

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[1] Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington (DC): National Academy; 2000. - PubMed

[2] Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington (DC): National Academy; 2000. - PubMed

[3] Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2002–2003. JAMA. 2003;290:1197–202. - PubMed

[4] Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2002–2003. JAMA. 2003;290:1197–202. - PubMed

[5] Dasenbrock HH, Clarke MJ, Thompson RE, et al. The impact of July hospital admission on outcome after surgery for spinal metastases at academic medical centers in the United States, 2005 to 2008. Cancer. 2012;118:1429–38. - PubMed

[6] Dasenbrock HH, Clarke MJ, Thompson RE, et al. The impact of July hospital admission on outcome after surgery for spinal metastases at academic medical centers in the United States, 2005 to 2008. Cancer. 2012;118:1429–38. - PubMed

[7] Kestle JR, Cochrane DD, Drake JM. Shunt insertion in the summer: Is it safe? J Neurosurg. 2006;105:165–8. - PubMed

[8] Kestle JR, Cochrane DD, Drake JM. Shunt insertion in the summer: Is it safe? J Neurosurg. 2006;105:165–8. - PubMed

[9] Englesbe MJ, Pelletier SJ, Magee JC, et al. Seasonal variation in surgical outcomes as measured by the American College of Surgeons —National Surgical Quality Improvement Program (ACS-NSQIP) Ann Surg. 2007;246:456–62. discussion 463–5. - PMC - PubMed

[10] Englesbe MJ, Pelletier SJ, Magee JC, et al. Seasonal variation in surgical outcomes as measured by the American College of Surgeons —National Surgical Quality Improvement Program (ACS-NSQIP) Ann Surg. 2007;246:456–62. discussion 463–5. - PMC - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract
in English, French

Figures

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Abstract in English, French

Figures

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Abstract
in English, French