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The "July effect" in total shoulder arthroplasty.

Allison J Rao1, Daniel D Bohl1, Rachel M Frank1

  • 1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.

Journal of Shoulder and Elbow Surgery
|December 5, 2016
PubMed
Summary

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This study found no evidence of a "July effect" in primary total shoulder arthroplasty (TSA) outcomes. Patient safety is not compromised when scheduling elective TSA procedures at teaching hospitals during July.

Area of Science:

  • Orthopedic Surgery
  • Patient Safety
  • Medical Education

Background:

  • The
  • July effect,
  • perceived increase in patient morbidity and mortality when new medical residents begin training in July, remains controversial across medical specialties.
  • Its existence in orthopedic surgery, specifically for primary total shoulder arthroplasty (TSA), has not been definitively established.

Purpose of the Study:

  • To investigate the presence of a
  • July effect
  • in primary total shoulder arthroplasty (TSA) outcomes.

Main Methods:

  • Analysis of primary TSA cases from 2005-2012 using the American College of Surgeons National Surgical Quality Improvement Program database.
  • Comparison of adverse event rates between cases involving residents/fellows and those without, and between cases performed during the first academic quarter (July-September) and the rest of the year.
Keywords:
American College of Surgeons National Surgical Quality Improvement ProgramJuly effectTotal shoulder arthroplastyresident involvementseasonal effectsurgical outcomes

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  • Multivariate logistic regression was employed to analyze composite and any adverse event outcomes.

    • Main Results:

    • A total of 1591 primary TSA patients were included; 44.7% involved residents or fellows, and 24.5% occurred in the first academic quarter.
    • Demographics and comorbidities showed minimal differences between groups.
    • The overall rate of serious adverse events was 1.6%, and any adverse events was 6.5%, with no significant difference attributed to the July start date or resident involvement.

    Conclusions:

    • This study, utilizing a large cohort of primary TSA patients, found no evidence to support a
    • July effect
    • in orthopedic surgery.
    • Patients can be reassured that elective TSA procedures at training institutions are safe to schedule at the beginning of the academic year.