The "July effect": Outcomes in microvascular reconstruction during resident transitions

• Published in: The Laryngoscope Vol. 130; no. 4; p. 893
• Main Authors: Bresler, Amishav Y, Bavier, Richard, Kalyoussef, Evelyne, Baredes, Soly, Park, Richard Chan Woo
• Format: Journal Article
• Language: English
• Published: United States 01.04.2020
• Subjects: microvascular reconstruction; July effect; Free flap; resident
• ISSN: 1531-4995
• DOI: 10.1002/lary.27988

To evaluate the "July effect," as a possible risk factor for perioperative complications in otolaryngology microvascular reconstruction during the transitional period in the academic calendar. Retrospective database review. Microvascular reconstruction outcomes in the National Surgical Quality Improvement Program (2005-2016) database were compared between the first academic quarter (July-September) to the last academic quarter (April-June). The primary outcome was 30-day morbidity, and secondary outcomes included 30-day mortality, operative complications, or postoperative adverse events. There were 612 and 580 patients who underwent microvascular reconstruction during the first and last academic quarters, respectively. There was no significant difference between the 30-day mortality between the first academic quarter (1.5%) and the last academic quarter (0.7%) (P = .194). There was no difference in 30-day morbidity (47.9% vs. 49.5%, P = .586), operative complications (wound disruption, P = .151; bleeding, P = .526; operative time, P = .162), or postoperative adverse events (deep vein thrombosis, P = .460; pneumonia, P = .737; reintubation, P = .201; pulmonary embolism, P = .452; ventilation for >48 hours, P = .769; acute renal failure, P = .500; urinary tract infection, P = .693; unplanned readmission, P = .202; and mean length of stay, P = .497). There appears to be no July effect in microvascular reconstruction. Further studies should identify the mechanisms that preserve the safety of this operation year-round for application to other areas of medicine who have observed the July effect. NA Laryngoscope, 130:893-898, 2020.