Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Ann Thorac Surg. 2019 Sep;108(3):929-934. doi: 10.1016/j.athoracsur.2019.06.015. Epub 2019 Jul 25.
Recent studies in noncardiac surgery have described worse outcomes in the first month of training. However, the "July effect" in the context of cardiac surgery outcomes is not well understood. We examined whether patient outcomes after cardiac surgery were affected by procedure month or academic year quartile.
Using the National Inpatient Sample, we isolated all coronary artery bypass grafting (CABG), surgical aortic valve replacement (AVR), mitral valve repair or replacement (MV), and isolated thoracic aortic aneurysm (TAA) replacement procedures between 2012 and 2014. For each procedure, overall trends in in-hospital mortality and hospital complications were compared by academic year quartiles (ie, between the first academic year quartile vs the fourth quartile) and by procedure month. Outcomes between teaching and nonteaching hospitals were also compared.
Overall, 301,105 CABG, 111,260 AVR, 54,985 MV, and 2,655 TAA procedures met inclusion criteria. In-hospital mortality for each procedure did not vary by procedure month or academic year quartile, even after risk adjustment (all P > .05). Teaching status did not influence risk-adjusted mortality for CABG and isolated TAA replacement (both P > .05). However, teaching hospitals had significantly lower adjusted mortality than nonteaching hospitals for AVR and MV surgery (both P < .01).
The July effect is not evident for cardiac surgery despite preexisting notions. Teaching hospitals performed at least equivalent, if not better, for major cardiac surgery procedures. These findings highlight the pivotal role of hospital support systems to ensure the safe transition of resident classes without compromising on patient outcomes.
最近的非心脏手术研究表明，在培训的第一个月内，结果较差。然而，心脏手术结果中的“七月效应”尚不清楚。我们研究了心脏手术后患者的结局是否受到手术月份或学术年四分位数的影响。
我们使用国家住院患者样本，从 2012 年至 2014 年期间，确定了所有冠状动脉旁路移植术（CABG）、主动脉瓣置换术（AVR）、二尖瓣修复或置换术（MV）和孤立性胸主动脉瘤（TAA）置换术。对于每种手术，通过学术年四分位数（即第一学术年四分位数与第四四分位数）和手术月份比较住院死亡率和医院并发症的总体趋势。还比较了教学医院和非教学医院的结果。
共有 301,105 例 CABG、111,260 例 AVR、54,985 例 MV 和 2,655 例 TAA 手术符合纳入标准。即使在风险调整后，每种手术的住院死亡率均不受手术月份或学术年四分位数的影响（均 P >.05）。教学状态并未影响 CABG 和孤立性 TAA 置换术的风险调整死亡率（均 P >.05）。然而，与非教学医院相比，教学医院的 AVR 和 MV 手术的调整后死亡率明显较低（均 P <.01）。
尽管存在先入为主的观念，但心脏手术中没有“七月效应”。教学医院至少在主要心脏手术程序方面表现出同等或更好的效果。这些发现强调了医院支持系统在确保住院医师班级安全过渡而不影响患者结局方面的关键作用。
