Tobert Daniel G, Menendez Mariano E, Ring David C, Chen Neal C
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA.
Harvard Combined Orthopaedic Residency Program, Boston MA, USA.
Arch Bone Jt Surg. 2018 Jul;6(4):277-281.
The "July effect" is a colloquialism asserting an increased rate of errors at the start of the academic year in teaching hospitals. This retrospective population-based study evaluated for the presence of the July effect in performing shoulder arthroplasty.
Using the Nationwide Inpatient Sample for 2002 through 2011, a total of 178,590 patients undergoing shoulder arthroplasty at academic medical centers were identified and separated into 2 groups: 1) patients admitted during July and 2) patients admitted between August and June. Multivariable logistic regression was used to identify associations with inpatient mortality and adverse events, blood transfusion, prolonged length of stay (>75 percentile) and non-routine discharge.
After adjusting for patient, procedure, and hospital characteristics in multivariable modeling, admission in July was not associated with increased risk for inpatient mortality (OR 1.6) aggregate morbidity, blood transfusion, prolonged length of stay, and non-routine discharge.
This nationwide database analysis shows that shoulder arthroplasty at academic medical centers is not associated with increased perioperative morbidity and resource utilization during the month of July.
“七月效应”是一种通俗说法，指教学医院在学年开始时错误率上升。这项基于人群的回顾性研究评估了在进行肩关节置换术时是否存在“七月效应”。
利用2002年至2011年的全国住院患者样本，共识别出178590例在学术医疗中心接受肩关节置换术的患者，并将其分为两组：1）7月入院的患者；2）8月至6月入院的患者。采用多变量逻辑回归分析来确定与住院死亡率、不良事件、输血、住院时间延长（>第75百分位数）和非常规出院的相关性。
在多变量模型中对患者、手术和医院特征进行调整后，7月入院与住院死亡率增加（比值比1.6）、总体发病率、输血、住院时间延长和非常规出院风险增加无关。
这项全国性数据库分析表明，学术医疗中心的肩关节置换术与7月份围手术期发病率增加和资源利用增加无关。
