Are Neurosurgeons Impacted By “The July Effect?”

Category: Spine Surgery, Surgeons | Author: Stefano Sinicropi | Date: May 26, 2016

surgeon july effect

The July Effect is a medical theory that suggests that more medical and surgical errors occur during the month of July. This is the month in which fourth year medical students become interns and residents advance to higher levels of training, when they inevitably face greater challenges and more responsibility.

The July Effect

It’s a theory based in sound logic, but do the numbers actually support the claims that there are more medical errors in July? Researchers out of Columbia University decided to put the theory to the test when it comes to neurosurgery. For their study, researchers examined over 16,000 neurosurgical operations recorded in the American College of Surgeons National Surgical Quality Improvement Program database (ACS NSQIP). The patients they examined underwent one of four operations: Spine surgery, cranial surgery, open vascular surgery and subarachnoid hemorrhage. Researchers also tracked post-operative outcomes and the quarter during which the surgery was performed, with Q1 representing July-September, Q2 representing October-December, Q3 representing January-March and Q4 representing April-June.

July Effect Study Results

After looking at the data, researchers uncovered:

  • There was no statistical difference in neurosurgical patient outcomes (complications or mortality rates) when comparing surgeries from Q1 to Q4.
  • There was no evidence of decreased efficiency during Q1 compared to Q4.
  • There was a slight increase in the rate of surgical complications during Q1 for surgeries involving junior residents, which was attributed to a modest increase in transfusions and an increase in the rate of repeated operations observed for cases involving senior resident participation.

In the end, while the study authors noted that the July transition period is “fraught with clinical challenges,” the statistics show that there is “no clear evidence for an increase in rates of morbidity or mortality during this transition period. If there is a July Effect, the effect size is probably too small to detect.”

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