Does Time Matter? Impact of Residency Start Month on EGS Outcome in Pakistan

Trainee turnover in hospitals with induction of new, less experienced residents and changeover in the clinical teams has been considered an essential factor for increased morbidity and mortality. In high-income countries (HICs), this is known as the July effect-the time for new inductees. We aim to study the January effect (time of new inductees in our setting) and patient outcomes in an Emergency General Surgery (EGS) cohort.

We used secondary data from adult patients with EGS diagnosis from a tertiary care center in Pakistan (2010-2019). The outcomes of interest were severe adverse events (SAEs), inpatient mortality, length of stay [LOS], and failure to rescue (FTR). Multiple logistic and linear regressions was performed to assess their association.

Of the 32,280 patients analyzed, 7.94% were admitted in January. There was significantly higher elective admission (61.06% vs. 53.51%) and surgical interventions (74.80% vs. 72.92%) in January compared to other months. Inpatient mortality, SAEs, FTRs, and LOS did not significantly differ between the two groups. Multivariable analysis showed no significant association of January admission with SAE (AOR 1.06; 95% CI 0.97-1.16), inpatient mortality (AOR 1.09; 95% CI 0.83-1.43), FTR (AOR 1.04; 95% CI 0.78-1.38), and LOS (β 0.12; 95% CI -0.05-0.29).

The results of the study, which has no evidence of the January effect for EGS patients, suggest that this effect is not universally applicable, necessitating context-specific evaluation to understand the temporal trends in the overall health outcomes of the admitted patients.