Bohl Daniel D, Fu Michael C, Gruskay Jordan A, Basques Bryce A, Golinvaux Nicholas S, Grauer Jonathan N
From the Yale School of Medicine, New Haven, CT.
Spine (Phila Pa 1976). 2014 Apr 1;39(7):603-11. doi: 10.1097/BRS.0000000000000196.
Retrospective cohort.
To evaluate for the presence and magnitude of the "July effect" within elective spine surgery.
The July effect is the hypothetical increase in morbidity and mortality thought to be associated with the influx of new (or newly promoted) trainees during the first portion of the academic year. Studies evaluating for the presence and magnitude of the July effect have demonstrated conflicting results.
We accessed the American College of Surgeons National Surgical Quality Improvement Program database from 2005-2010. Statistical analyses were conducted using bivariate and multivariate logistic regression.
A total of 14,986 cases met inclusion criteria and constitute the study population. Of these, 26.5% occurred in the first academic quarter and 25.3% had resident involvement. The rate of serious adverse events was 1.9 times higher and the rate of any adverse events was 1.6 times higher among cases with resident involvement than among those without (P < 0.001 for both). Among cases without resident involvement, the rates of serious adverse events and any adverse events did not differ by academic quarter. Similarly, among cases with resident involvement, the rates of serious adverse events and any adverse events did not differ by academic quarter.
We could not demonstrate that the training of new (or newly promoted) residents is associated with an increase in the adverse events of spine surgery. Safeguards that have been put in place to ensure patient safety during this training period seem to be effective. Although adverse events were more common among cases with resident involvement than among cases without resident involvement, our data suggest that this association is more likely a product of the riskier population of cases in which residents participate than of the resident involvement itself.
回顾性队列研究。
评估择期脊柱手术中“七月效应”的存在情况及影响程度。
“七月效应”是一种假设，即学年第一阶段新（或新晋升）实习生的涌入被认为会导致发病率和死亡率上升。评估“七月效应”存在情况及影响程度的研究结果相互矛盾。
我们获取了美国外科医师学会国家外科质量改进计划2005年至2010年的数据库。使用双变量和多变量逻辑回归进行统计分析。
共有14986例病例符合纳入标准，构成研究人群。其中，26.5%发生在第一学年季度，25.3%有住院医师参与。有住院医师参与的病例中严重不良事件发生率高1.9倍，任何不良事件发生率高1.6倍（两者P均<0.001）。在无住院医师参与的病例中，严重不良事件和任何不良事件的发生率在各学年季度之间无差异。同样，在有住院医师参与的病例中，严重不良事件和任何不良事件的发生率在各学年季度之间也无差异。
我们未能证明新（或新晋升）住院医师的培训与脊柱手术不良事件增加有关。在此培训期间为确保患者安全而采取的保障措施似乎是有效的。尽管有住院医师参与的病例中不良事件比无住院医师参与的病例更常见，但我们的数据表明，这种关联更可能是住院医师参与的病例风险较高人群的产物，而非住院医师参与本身。
