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Deconstructing the “July Effect” in Operative Outcomes: A National Study

  • 2015 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery

An Erratum to this article was published on 09 June 2016

Abstract

This study analyzes the relationship between hospital teaching status, failure to rescue, and time of year in select gastrointestinal operations. Procedure codes for laparoscopic cholecystectomy, colectomy, and pancreatectomy were queried from the Nationwide Inpatient Sample (2004–2011). Failure to rescue was defined as inpatient mortality when ≥1 complication. A total of 2,777,267 laparoscopic cholecystectomies, 2,519,903 colectomies, and 129,619 pancreatectomies were performed. Teaching hospitals had increased overall rates of failure to rescue compared to non-teaching hospitals, 10.0 vs. 9.5 % (p = 0.0187), particularly between May and August. There was greater inter-month variability in non-teaching hospitals amongst individual operations. On multivariable analysis, July was not predictive of increased odds of failure to rescue. Teaching status, hospital characteristics, and patient demographics were associated with increased odds of failure to rescue. Although teaching hospitals have a higher overall failure to rescue rate amongst the selected gastrointestinal operations, odds of failure to rescue are not increased in the month of July. Non-teaching hospitals tend to exhibit more monthly variation in failure to rescue rates, and hospital/patient demographics are predictive of failure to rescue. Further investigation targeted at identifying drivers of temporal variation is warranted to optimize patient outcomes.

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Acknowledgment

The authors would like to acknowledge the awarding of the Howard Hughes Medical Institute Early Career Award, American Surgical Association Foundation Fellowship, American Cancer Society MSRG 10-003-01 (to JFT) and the Hartford Hospital Pyrtek Fund Research Fellowship (to LAB).

This manuscript was presented as a brief oral presentation at the Digestive Disease Week/SSAT in the SSAT Quick Shots: Small bowel and colorectal surgery section on May 19, 2015 in Washington, DC.

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Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA

    Ammara A. Watkins, Lindsay A. Bliss, Jennifer F. Tseng & Tara S. Kent

  2. Boston Children’s Hospital, 300 Longwood Ave., Boston, MA, 02115, USA

    Danielle B. Cameron

Authors
  1. Ammara A. Watkins
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  2. Lindsay A. Bliss
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  3. Danielle B. Cameron
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  4. Jennifer F. Tseng
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  5. Tara S. Kent
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Corresponding author

Correspondence to Tara S. Kent.

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This study was deemed exempt by the Beth Israel Deaconess Medical Center Institutional Review Board.

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Watkins, A.A., Bliss, L.A., Cameron, D.B. et al. Deconstructing the “July Effect” in Operative Outcomes: A National Study. J Gastrointest Surg 20, 1012–1019 (2016). https://doi.org/10.1007/s11605-016-3120-4

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  • DOI: https://doi.org/10.1007/s11605-016-3120-4

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