Assessment of the July Effect on Bronchoscopies in Teaching Hospitals Across the United States

The July effect is the perceived notion that at the start of each academic year there is an increase in medical complications as the novice physician begins their new respective roles. Our study evaluated complication rates in the beginning versus end of the academic year with regards to bronchoscopy.

This is a retrospective cohort study using the 2016 and 2017 Nationwide Inpatient Sample. Patients in the database that underwent bronchoscopy at teaching hospitals were determined using ICD-10 procedure codes. Our outcomes included length of hospital stay and several bronchoscope complications. We compared our outcomes in the first quarter of the academic year (July, August, and September) to the last quarter (April, May, and June). Multivariable logistic and linear regression analysis were used accordingly to adjust for confounders.

There was a total of 189,720 admission for bronchoscopy. Of these hospitalization 89,020 bronchoscopies were done in first academic Quarter (Q1) while 100,700 bronchoscopies were done in fourth academic Quarter (Q4) in 2016 to 2017 academic year. After adjusting for confounders, there was no difference in any postprocedural complications between Q1 and Q4 or length of stay.

Within the limitation of the national data set provided, there appears to be similar procedural complication rates for patients admitted Q1 compared with Q4 of the academic year in respect to bronchoscopy, signaling the possibility of lack of the July effect. Prospective studies with improved data granularity is needed to further verify the absence or presence of the July effect regarding bronchoscopy.