According to research published online today in the Journal of Neurosurgery, there is no ‘July effect’ found in the field of neurosurgery.
In American hospitals, July is the month when medical students become interns and existing residents move up to higher levels of training, responsibility, and challenges. This combination of inexperienced new staff and increased burdens on existing health workers is theorized to result in an increase in medical and surgical errors that causes more patients to die or suffer slower recoveries—termed the July effect.
A number of studies have been done on the effect in the past and depending on which study is consulted, the effect either doesn’t exist, does exist, exists only in certain disciplines, exists only in certain types of injuries or operations, exists only in certain types of patients, or is inconclusive.
To test whether the July effect existed in neurosurgery, the study authors examined neurosurgical cases conducted between 2006 and 2012. In total, 16,343 cases where residents were part of the surgical team were compared alongside 20,792 cases where residents were not participants. Adult neurosurgery cases were targeted along with four subgroups: spinal surgery, cranial surgery, open vascular surgery, and surgery to treat subarachnoid hemorrhage (bleeding in the brain).
The data was only available by quarter, rather than month, but still provided a way to assess whether there were any differences in postoperative outcomes, deaths, and surgical complications. The researchers focused their efforts on comparing the first quarter (July-September) to the fourth (April-June). This is because, if the July Effect was present, the first quarter would have a higher rate of adverse outcomes and the fourth quarter—the period when new residents would be at their most experienced—would have lower.
Mortality and other complications both during and for 30 days after surgery were examined including pneumonia, stroke, blood clots, surgical site infections, heart attacks, duration of surgeries, and length of entire hospital stay. Multiple levels of resident education were compared as well.
With two exceptions, no significant differences in mortality or complications were found between the first and fourth quarters across the dataset. The differences that were noticed were among surgical complications involving junior-level residents (1.58% higher rate) that required transfusions and in the rate of repeat operations (0.46% higher rate) where senior residents were involved. Although not overly large, the differences were statistically significant.
Due to how limited the adverse findings were the researchers concluded that the July effect is not present in neurosurgery.
Source for Today’s Article:
Lieber, B., et al., “Assessment of the “July Effect”: Outcomes after Early Resident Transition in Adult Neurosurgery,” Journal of Neurosurgery, 2015; 2015. doi:10.3171/2015.4.JNS142149.