Zuk Keegan, Jensen Derek, Gills Jessie, Wyre Hadley, Holzbeierlein Jeffrey M, Lopez-Corona Ernesto, Lee Eugene K
Department of Urology, University of Kansas Medical Center , Kansas City, KS, USA.
Bladder Cancer. 2016 Oct 27;2(4):433-439. doi: 10.3233/BLC-160059.
The "July effect" is the potential effect that new and recently promoted residents have on patient care during the first months of the academic year. Literature suggests that the July effect may worsen patient outcomes and lead to systemic inefficiencies. We evaluate the July effect on mortality, morbidity, and efficiency outcomes in patients undergoing radical cystectomy. A chart review was performed in patients who underwent radical cystectomy between January 2008 and April 2012. Demographic information was abstracted from patient charts and outcomes compared between operations performed in July, September, and November (first month of each resident's university rotation) to the remainder of the year. Outcomes of interest included mortality, complications, and markers of efficiency (operative time, length of hospital stay, and estimated blood loss). Two hundred and fifty one patients were included in the analysis. There were no major differences in mortality or morbidity between the July, September, November group and the rest of the year. Multivariable analysis demonstrates a trend for operations performed in the months of July, September, and November to be associated with longer OR times 2.06 (0.99-4.27), = 0.053. Length of hospital stay and estimated blood loss were no different between the two groups. These data demonstrate no increase in mortality or morbidity during the early academic period. Additionally, while there is a trend for OR time to be longer in the early group, length of hospital stay and estimated blood loss were no different. These data may be used as an impetus to continue to investigate technical/clinical teaching practices, strategies to assess resident progression, and to initiate protocols to support residents early in the academic year in efforts to prevent inefficiencies.
“七月效应”指的是新入职及近期晋升的住院医师在学年开始的头几个月对患者护理产生的潜在影响。文献表明，“七月效应”可能会使患者预后恶化，并导致系统效率低下。我们评估了“七月效应”对接受根治性膀胱切除术患者的死亡率、发病率和效率结果的影响。对2008年1月至2012年4月期间接受根治性膀胱切除术的患者进行了病历回顾。从患者病历中提取人口统计学信息，并将7月、9月和11月（每位住院医师大学轮转的第一个月）进行的手术与当年其余时间进行的手术的结果进行比较。感兴趣的结果包括死亡率、并发症和效率指标（手术时间、住院时间和估计失血量）。251名患者纳入分析。7月、9月、11月组与当年其余时间相比，死亡率或发病率无显著差异。多变量分析显示，7月、9月和11月进行的手术有与较长手术时间相关的趋势，为2.06（0.99 - 4.27），P = 0.053。两组之间的住院时间和估计失血量没有差异。这些数据表明，在学年早期死亡率和发病率没有增加。此外，虽然早期组的手术时间有延长的趋势，但住院时间和估计失血量没有差异。这些数据可作为继续研究技术/临床教学实践、评估住院医师进展的策略以及启动协议以在学年早期支持住院医师以防止效率低下的动力。
