RT Journal Article
SR Electronic
T1 Is there any evidence of a “July effect” in patients undergoing major cancer surgery?
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 82
OP 88
DO 10.1503/cjs.002713
VO 57
IS 2
A1 Praful Ravi
A1 Vincent Q. Trinh
A1 Maxine Sun
A1 Jesse Sammon
A1 Shyam Sukumar
A1 Mai-Kim Gervais
A1 Shahrokh F. Shariat
A1 Simon P. Kim
A1 Keith J. Kowalczyk
A1 Jim C. Hu
A1 Mani Menon
A1 Pierre I. Karakiewicz
A1 Quoc-Dien Trinh
YR 2014
UL http://canjsurg.ca/content/57/2/82.abstract
AB 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.