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July Effect in Obstetric Outcomes.

Megan Pagan1, Ann Marie Mercier1, Dayna Whitcombe1

  • 1Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.

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The July effect minimally impacts obstetric outcomes, with slightly longer postpartum stays in July-September. Wound infections were more common before July, potentially due to resident experience levels.

Keywords:
July effectinternsobstetric outcomesobstetricsresidents

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Area of Science:

  • Obstetrics and Gynecology
  • Medical Education
  • Patient Safety

Background:

  • The July effect, when medical residents advance roles, is poorly studied in Obstetrics and Gynecology.
  • No prior studies have specifically evaluated its impact on obstetric outcomes.
  • This study addresses the knowledge gap regarding the July effect in labor and delivery settings.

Purpose of the Study:

  • To investigate the influence of the July effect on key obstetric outcomes.
  • To compare maternal and neonatal outcomes between the July-September period (Quarter 1) and April-June period (Quarter 4).

Main Methods:

  • A retrospective cohort study design was employed.
  • Delivery outcomes between Quarter 1 (July-September) and Quarter 4 (April-June) from 2017-2020 were compared.
  • Evaluated outcomes included postpartum length of stay, readmissions, wound complications/infections, blood transfusions, estimated blood loss, lacerations, APGAR scores, and cesarean rates.

Main Results:

  • A higher incidence of wound infections occurred during April-June (0.68%) compared to July-September (0.27%).
  • Postpartum length of stay was slightly longer in July-September (1.7 days) versus April-June (1.6 days).
  • No significant differences were observed in other evaluated obstetric outcomes.

Conclusions:

  • The July effect appears to have a minimal impact on overall obstetric complications.
  • Slightly longer postpartum length of stay in July-September may be attributed to less experienced residents.
  • Higher wound infection rates in April-June could be linked to the transition of new residents to primary surgical roles.