Related Experiment Video
Updated: Mar 2, 2026
Modeling Posthemorrhagic Hydrocephalus of Prematurity in Rats
Published on: March 28, 2025
Is there a "July effect" in pediatric neurosurgery?
Yimo Lin1, Rory R Mayer2,3, Terence Verla2,3
1Department of Neurosurgery, Oregon Health and Sciences University, Portland, OR, USA.
Insights
The "July effect" in pediatric neurosurgery showed no significant increase in most patient complications during the first academic quarter. However, some specific issues like pneumonia and re-operations were more frequent in the first quarter.
Area of Science:
- Neurosurgery
- Patient Safety
- Healthcare Quality
Background:
- The
Purpose of the Study:
- To investigate the association between the start of the academic year and patient outcomes in pediatric neurosurgery.
- To compare complication rates in pediatric neurosurgical procedures between the first and last academic quarters.
Main Methods:
- Utilized data from the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) and the Kids' Inpatient Database (KID) for 2012.
- Analyzed 30-day and in-hospital complication events after pediatric neurosurgical procedures.
- Employed descriptive and analytic statistical methods to assess seasonal variations.
Main Results:
- No significant differences in most complication rates (e.g., wound infections, nerve injury, death) between the first and last academic quarters.
- The first quarter showed a higher incidence of pneumonia and unplanned re-operations in the NSQIP-P dataset.
- No significant differences in pneumonia or sepsis rates were found in the KID dataset.
Conclusions:
- The majority of patient morbidity and mortality events did not differ significantly between the first and last academic quarters.
- While most outcomes were similar, specific complications like pneumonia warrant further attention during the initial training period.
Purpose:
The belief that July, when resident physicians' training year begins, may be associated with increased risk of patient morbidity and mortality is known as the "July effect." This study aimed to compare complication rates after pediatric neurosurgical procedures in the first versus last academic quarters in two national datasets.
Methods:
Data were extracted from the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database for year 2012 for 30-day complication events and the Kids' Inpatient Database (KID) for year 2012 for in-hospital complication events after pediatric neurosurgical procedures. Descriptive and analytic statistical methods were used to characterize the impact of seasonal variation between the first and last quarters on complications.
Results:
Three thousand six hundred twenty-four procedures in the NSQIP-P dataset and 14,855 hospitalizations in KID were included in the study cohort. No significant difference was observed between the first and fourth quarters for these complication events: wound disruption/dehiscence, wound infection, nerve injury, bleeding requiring transfusion, central line-associated BSI, deep venous thrombosis/pulmonary embolism, urinary tract infection, renal failure, re-intubation/pulmonary failure, cardiac arrest, stroke, coma, and death. There was no difference in the average length of stay or average length of surgical time. In the NSQIP-P, the first quarter was associated with a significantly increased incidence of pneumonia and unplanned re-operation; there was a trend towards increased incidence of unplanned re-admission and sepsis. In KID, there was no difference in the rate of pneumonia or sepsis.
Conclusion:
For the majority of morbidity and mortality events, no significant difference was found in occurrence rates between the first and last quarters.
Related Concept Videos
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution