2016年至2021年美国肺栓塞住院患者管理及预后中的“七月效应”

'July effect' in management and outcomes of patients admitted with pulmonary embolism in the United States, 2016 to 2021.

作者信息

Bansal Mridul, Mehta Aryan, Morris D Lynn, Mehta Chirag, Jentzer Jacob C, van Diepen Sean, Abbott J Dawn, Vallabhajosyula Saraschandra

机构信息

Department of Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA.

Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.

出版信息

Proc (Bayl Univ Med Cent). 2025 Jul 8;38(5):675-682. doi: 10.1080/08998280.2025.2520125. eCollection 2025.

DOI:10.1080/08998280.2025.2520125

PMID:40821483

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12351753/

Abstract

BACKGROUND

This study sought to assess the outcomes of pulmonary embolism (PE) admissions at teaching and nonteaching hospitals in the month of July, when new trainees begin their training in the United States.

METHODS

During 2016-2021, adult (≥18 years) nonelective admissions with PE, admitted to urban teaching hospitals in the months of May and July, were identified using the National Inpatient Sample and compared to nonteaching admissions. Outcomes of interest included in-hospital mortality, complications, variations in management, total hospitalization costs, and hospitalization duration.

RESULTS

From January 1, 2016, to December 31, 2021, 164,244 PE admissions were identified in May and July to teaching (76.5%) and nonteaching (23.5%) hospitals. The May and July cohorts had comparable baseline characteristics at both teaching and nonteaching hospitals. The rates of organ failure, noncardiac and cardiac organ support, cardiogenic shock, and cardiac arrest were comparable across all four cohorts. Use of systemic thrombolysis (3.8% vs 3.1%; = 0.002) and catheter-directed therapies (4.1% vs 3.8%; = 0.05) were higher in the teaching hospitals in July than in May, but there were no differences in nonteaching hospitals. The cohorts of teaching (3.0% vs 3.3%, = 0.30) and nonteaching hospitals (2.7% vs 2.2%, = 0.15) had comparable adjusted in-hospital mortality in May and July. Hospitalization duration, total hospitalization costs, and discharge disposition were comparable in all four cohorts.

CONCLUSION

In this large 6-year US analysis, there were no differences in the outcomes of PE admissions to teaching and nonteaching hospitals in the months of May and July, arguing against the 'July effect.'

摘要

背景

本研究旨在评估7月美国教学医院和非教学医院肺栓塞（PE）住院患者的治疗结果，此时新学员开始在美国接受培训。

方法

在2016 - 2021年期间，利用全国住院患者样本确定5月和7月入住城市教学医院的成年（≥18岁）非选择性PE住院患者，并与非教学医院的患者进行比较。感兴趣的结果包括院内死亡率、并发症、治疗差异、总住院费用和住院时间。

结果

2016年1月1日至2021年12月31日期间，在5月和7月确定了164,244例入住教学医院（76.5%）和非教学医院（23.5%）的PE住院患者。5月和7月的队列在教学医院和非教学医院具有可比的基线特征。所有四个队列的器官衰竭、非心脏和心脏器官支持、心源性休克和心脏骤停发生率相当。7月教学医院全身溶栓治疗（3.8%对3.1%；P = 0.002）和导管定向治疗（4.1%对3.8%；P = 0.05）的使用率高于5月，但非教学医院无差异。教学医院（3.0%对3.3%，P = 0.30）和非教学医院（2.7%对2.2%，P = 0.15）队列在5月和7月的调整后院内死亡率相当。所有四个队列的住院时间、总住院费用和出院处置情况相当。