Department of Surgery, Albert Einstein Hospital, Philadelphia, Pennsylvania.
J Surg Educ. 2013 Sep-Oct;70(5):669-79. doi: 10.1016/j.jsurg.2013.04.012. Epub 2013 May 28.
In the beginning of the academic year, medical errors are often attributed to inexperienced medical staff. This potential seasonal influence on health care outcomes is termed the "July effect." No study has demonstrated the July effect in liver transplantation. We reviewed retrospectively collected data from the United Network for Organ Sharing for patients who underwent liver transplantation from October 1987 to June 2011 to determine if surgical outcomes were worse in July compared with rest of the year. We found no clinical difference in early graft survival (91.11% vs. 90.72%, p = 0.045) and no difference in early patient survival (94.71% vs. 94.42%, p = 0.057). Survival at 1 year, 3 years, and 5 years was also compared and no notable differences were detected. Because the Model for End-stage Liver Disease (MELD) score implementation in 2002 affected the acuity of liver transplant recipients, we further stratified our data to compare pre- and post-MELD survival to remove subjectivity as a confounding factor. MELD stratification revealed no seasonal difference in outcomes. There was no difference in rate of graft failure and acute and chronic rejection between groups. Our findings show no evidence of the July effect in liver transplantation. Each July, thousands of medical residents take on new responsibilities in patient care. It has been suggested that these new practitioners may produce errors that contribute to worse patient outcomes in the beginning of the academic year-a phenomenon called the "July effect." Currently, there are few research studies with controversial evidence of poorer outcomes in July, and no articles address the effect of new medical staff in the setting of liver transplantation. Our study compares short-, medium-, and long-term graft and patient survival between July and August and the remaining months using national data. We also examine survival before and after the implementation of the MELD scoring system to determine its effect on outcomes in the beginning of the academic year.
在学年开始时，医疗错误通常归因于经验不足的医务人员。这种对医疗保健结果的潜在季节性影响被称为“七月效应”。目前还没有研究表明在肝移植中存在“七月效应”。我们回顾性地分析了 1987 年 10 月至 2011 年 6 月期间接受肝移植的患者的 United Network for Organ Sharing 收集的数据，以确定与一年中的其他时间相比，7 月的手术结果是否较差。我们发现早期移植物存活率（91.11%比 90.72%，p=0.045）和早期患者存活率（94.71%比 94.42%，p=0.057）没有临床差异。1 年、3 年和 5 年的生存率也进行了比较，没有发现显著差异。由于 2002 年实施的终末期肝病模型（MELD）评分影响了肝移植受者的疾病严重程度，我们进一步对数据进行分层，以比较 MELD 评分前后的生存率，以消除作为混杂因素的主观性。MELD 分层显示结果没有季节性差异。两组之间在移植物失功、急性和慢性排斥反应的发生率上没有差异。我们的研究结果表明肝移植中没有“七月效应”的证据。每年 7 月，数千名住院医师开始承担新的患者护理责任。有人认为，这些新的从业者可能会在学年开始时产生错误，从而导致患者的预后更差，这种现象被称为“七月效应”。目前，只有少数研究有争议地证明 7 月的结果更差，也没有文章探讨新医务人员在肝移植中的作用。我们的研究使用全国数据比较了 7 月和 8 月以及其余月份的短期、中期和长期移植物和患者生存率。我们还检查了 MELD 评分系统实施前后的生存率，以确定其对学年开始时结果的影响。
