Gangu Karthik, Basida Sanket, Awan Rehmat Ullah, Butt Mohammad Ali, Reed Austin, Afzal Rao, Shekhar Rahul, Chela Harleen Kaur, Daglilar Ebubekir S, Sheikh Abu Baker
Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Department of Internal Medicine, University of Missouri System, Columbia, Missouri.
Proc (Bayl Univ Med Cent). 2023 May 8;36(4):478-482. doi: 10.1080/08998280.2023.2204804. eCollection 2023.
Esophagogastroduodenoscopy (EGD) is a common procedure used for both diagnosis and treatment, but carries risks such as bleeding and perforation. The "July effect"-described as increased complication rates during the transition of new trainees-has been studied in other procedures, but has not been thoroughly evaluated for EGD.
We used the National Inpatient Sample database for 2016 to 2018 to compare outcomes in EGD performed between July to September and April to June.
Approximately 0.91 million patients in the study received EGD between July to September (49.35%) and April to June (50.65%), with no significant differences between the two groups in terms of age, gender, race, income, or insurance status. Of the 911,235 patients, 19,280 died during the study period following EGD, 2.14% (July-September) vs 1.95% (April-June), with an adjusted odds ratio of 1.09 ( < 0.01). The adjusted total hospitalization charge was $2052 higher in July-September ($81,597) vs April to June ($79,023) ( < 0.005). The mean length of stay was 6.8 days (July-September) vs 6.6 days (April-June) ( < 0.001).
The results of this study are reassuring as the July effect on inpatient outcomes for EGDs was not significantly different according to our study. We recommend seeking prompt treatment and improving new trainee training and interspecialty communication for better patient outcomes.
食管胃十二指肠镜检查（EGD）是一种常用于诊断和治疗的常见操作，但存在出血和穿孔等风险。“七月效应”——即在新学员交接期间并发症发生率增加——已在其他操作中得到研究，但尚未对EGD进行全面评估。
我们使用了2016年至2018年的全国住院患者样本数据库，比较7月至9月和4月至6月期间进行的EGD的结果。
研究中约91万患者在7月至9月（49.35%）和4月至6月（50.65%）接受了EGD，两组在年龄、性别、种族、收入或保险状况方面无显著差异。在911235例患者中，19280例在EGD后的研究期间死亡，7月至9月为2.14%，4月至6月为1.95%，调整后的优势比为1.09（<0.01）。7月至9月的调整后总住院费用（81597美元）比4月至6月（79023美元）高2052美元（<0.005）。平均住院时间为7月至9月6.8天，4月至6月6.6天（<0.001）。
本研究结果令人放心，因为根据我们的研究，“七月效应”对EGD住院患者结局的影响无显著差异。我们建议寻求及时治疗，并改善新学员培训和跨专业沟通，以获得更好的患者结局。
