Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Laryngoscope. 2013 Aug;123(8):1889-95. doi: 10.1002/lary.23884. Epub 2013 Jun 4.
OBJECTIVES/HYPOTHESIS: A "July effect" of increased complications when new trainees begin residency has been reported widely by the media. We sought to determine the effect of admission month on in-hospital mortality, complications, length of hospitalization, and costs for patients undergoing head and neck cancer (HNCA) surgery.
Retrospective cross-sectional study.
Discharge data from the Nationwide Inpatient Sample for 48,263 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2005 to 2008 were analyzed using cross-tabulations and multivariate regression modeling.
There were 3,812 cases admitted in July (8%). July admission was significantly associated with Medicaid (RRR 1.40, P = 0.011) or self-pay payor status (RRR 1.40, P = 0.022), medium hospital bed size (RRR 1.63, P = 0.033) and large hospital bed size (RRR 1.73, P = 0.013). There was no association between July admission and other patient or hospital demographic characteristics. Major procedures and comorbidity were significantly associated with in-hospital death, surgical and medical complications, length of hospitalization, and costs, but no association was found for July admission, July through September discharge, or teaching hospital status and short-term morbidity or mortality. Teaching hospitals and large hospital bed size were predictors of increased length of hospitalization and costs; and private, for profit hospitals were additionally associated with increased costs. No interaction between July admission and teaching hospitals was found for any of the outcome variables studied.
These data do not support evidence of a "July effect" or an increase in morbidity or mortality at teaching hospitals providing HNCA surgical care.
目的/假设：媒体广泛报道了新学员开始住院实习时并发症增加的“7 月效应”。我们旨在确定入院月份对头颈癌（HNCA）手术患者的住院死亡率、并发症、住院时间和费用的影响。
回顾性横断面研究。
使用交叉表和多变量回归模型分析了 2005 年至 2008 年间全国住院患者样本中 48263 例接受口腔、喉、下咽或口咽恶性肿瘤消融术患者的出院数据。
有 3812 例患者在 7 月入院（8%）。7 月入院与医疗补助（RRR1.40，P=0.011）或自付支付者身份（RRR1.40，P=0.022）、中等病床规模（RRR1.63，P=0.033）和大病床规模（RRR1.73，P=0.013）显著相关。7 月入院与其他患者或医院人口统计学特征之间没有关联。主要手术和合并症与住院期间死亡、手术和医疗并发症、住院时间和费用显著相关，但 7 月入院、7 月至 9 月出院或教学医院地位与短期发病率或死亡率之间没有关联。教学医院和大病床规模是住院时间和费用增加的预测因素；私立营利性医院还与费用增加相关。在研究的所有结果变量中，均未发现 7 月入院与教学医院之间存在相互作用。
这些数据不支持在提供 HNCA 手术治疗的教学医院中存在“7 月效应”或发病率或死亡率增加的证据。
