Lin Yimo, Mayer Rory R, Verla Terence, Raskin Jeffrey S, Lam Sandi
Department of Neurosurgery, Oregon Health and Sciences University, Portland, OR, USA.
Division of Pediatric Neurosurgery, Texas Children's Hospital, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Childs Nerv Syst. 2017 Aug;33(8):1367-1371. doi: 10.1007/s00381-017-3432-z. Epub 2017 May 13.
The belief that July, when resident physicians' training year begins, may be associated with increased risk of patient morbidity and mortality is known as the "July effect." This study aimed to compare complication rates after pediatric neurosurgical procedures in the first versus last academic quarters in two national datasets.
Data were extracted from the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database for year 2012 for 30-day complication events and the Kids' Inpatient Database (KID) for year 2012 for in-hospital complication events after pediatric neurosurgical procedures. Descriptive and analytic statistical methods were used to characterize the impact of seasonal variation between the first and last quarters on complications.
Three thousand six hundred twenty-four procedures in the NSQIP-P dataset and 14,855 hospitalizations in KID were included in the study cohort. No significant difference was observed between the first and fourth quarters for these complication events: wound disruption/dehiscence, wound infection, nerve injury, bleeding requiring transfusion, central line-associated BSI, deep venous thrombosis/pulmonary embolism, urinary tract infection, renal failure, re-intubation/pulmonary failure, cardiac arrest, stroke, coma, and death. There was no difference in the average length of stay or average length of surgical time. In the NSQIP-P, the first quarter was associated with a significantly increased incidence of pneumonia and unplanned re-operation; there was a trend towards increased incidence of unplanned re-admission and sepsis. In KID, there was no difference in the rate of pneumonia or sepsis.
For the majority of morbidity and mortality events, no significant difference was found in occurrence rates between the first and last quarters.
住院医师培训年度始于7月，人们认为这可能与患者发病和死亡风险增加有关，这一现象被称为“7月效应”。本研究旨在比较两个全国性数据集中第一与最后一个学术季度小儿神经外科手术后的并发症发生率。
从国家外科质量改进计划-儿科（NSQIP-P）数据库中提取2012年30天并发症事件的数据，以及从儿童住院数据库（KID）中提取2012年小儿神经外科手术后住院并发症事件的数据。使用描述性和分析性统计方法来描述第一季度和最后一个季度之间季节变化对并发症的影响。
研究队列纳入了NSQIP-P数据集中的3624例手术和KID中的14855例住院病例。在这些并发症事件中，第一季度和第四季度之间未观察到显著差异：伤口裂开/愈合不良、伤口感染、神经损伤、需要输血的出血、中心静脉导管相关血流感染、深静脉血栓形成/肺栓塞、尿路感染、肾衰竭、再次插管/呼吸衰竭、心脏骤停、中风、昏迷和死亡。住院平均时长或手术平均时长无差异。在NSQIP-P中，第一季度与肺炎和计划外再次手术的发生率显著增加相关；计划外再次入院和脓毒症的发生率有增加趋势。在KID中，肺炎或脓毒症的发生率无差异。
对于大多数发病和死亡事件，第一季度和最后一个季度的发生率未发现显著差异。
