Pagan Megan, Mercier Ann Marie, Whitcombe Dayna, Ounpraseuth Songthip T, Magann Everett F, Phillips Amy
Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
Int J Womens Health. 2022 Feb 9;14:149-154. doi: 10.2147/IJWH.S341044. eCollection 2022.
The July effect represents the month when interns begin residency and residents advance with increased responsibility. This has not been well studied in Obstetrics and Gynecology residencies and no study has been conducted evaluating obstetric outcomes. The purpose of this study was to evaluate the July effect on obstetric outcomes. Women who delivered between July and September (quarter 1) were compared to those delivering between April and June (quarter 4).
This retrospective cohort study compared outcomes of deliveries between quarter 1 and quarter 4 from 2017 to 2020. Outcomes evaluated were postpartum length of stay (LOS), postpartum readmission, wound complication, wound infection, blood transfusion, estimated blood loss, 3rd and 4th degree lacerations, 5 min APGAR scores, and cesarean delivery rates.
There were 3693 deliveries in quarter 1 and 3107 deliveries in quarter 4. There was a higher incidence Of wound infection during the April-June period (N = 21; 0.68%) compared to July-September (N = 10; 0.27%; p = 0.0135). Although LOS for both periods were the same, the average postpartum LOS during July-September was slightly longer than April-June (1.7 days; SD = 1.1 vs 1.6 days; SD = 1.2; p = 0.0026). All other pregnancy outcomes were similar between the two groups.
Overall, the July effect is minimal on obstetric complications. However, LOS between July and September may differ because all residents are less experienced in quarter 1. Wound infection rates were higher in April-June, perhaps because new PGY-1s went from assisting to primary on cesarean surgeries starting in the 4th quarter of the year.
“七月效应”指实习生开始住院医师培训以及住院医师承担更多职责的月份。这一现象在妇产科住院医师培训中尚未得到充分研究，也没有关于产科结局评估的研究。本研究的目的是评估“七月效应”对产科结局的影响。将7月至9月（第一季度）分娩的女性与4月至6月（第四季度）分娩的女性进行比较。
这项回顾性队列研究比较了2017年至2020年第一季度和第四季度的分娩结局。评估的结局包括产后住院时间（LOS）、产后再次入院、伤口并发症、伤口感染、输血、估计失血量、三度和四度会阴裂伤、5分钟阿氏评分以及剖宫产率。
第一季度有3693例分娩，第四季度有3107例分娩。与7月至9月（n = 10；0.27%；p = 0.0135）相比，4月至6月期间伤口感染的发生率更高（n = 21；0.68%）。虽然两个时期的住院时间相同，但7月至9月的平均产后住院时间略长于4月至6月（1.7天；标准差 = 1.1天对1.6天；标准差 = 1.2天；p = 0.0026）。两组之间的所有其他妊娠结局相似。
总体而言，“七月效应”对产科并发症的影响极小。然而，7月至9月的住院时间可能有所不同，因为所有住院医师在第一季度的经验较少。4月至6月的伤口感染率较高，可能是因为新的一年级住院医师从当年第四季度开始在剖宫产手术中从协助转为主要操作。
