Praful Ravi1, Vincent Q Trinh2, Maxine Sun2, Jesse Sammon1, Shyam Sukumar1, Mai-Kim Gervais3, Shahrokh F Shariat4, Simon P Kim5, Keith J Kowalczyk6, Jim C Hu7, Mani Menon1, Pierre I Karakiewicz2, Quoc-Dien Trinh8. 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.
Abstract
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.
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.
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