Is there a "July effect" for head and neck cancer surgery?


Journal Article

OBJECTIVES/HYPOTHESIS: A "July effect" of increased complications when new trainees begin residency has been reported widely by the media. We sought to determine the effect of admission month on in-hospital mortality, complications, length of hospitalization, and costs for patients undergoing head and neck cancer (HNCA) surgery. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Discharge data from the Nationwide Inpatient Sample for 48,263 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2005 to 2008 were analyzed using cross-tabulations and multivariate regression modeling. RESULTS: There were 3,812 cases admitted in July (8%). July admission was significantly associated with Medicaid (RRR 1.40, P = 0.011) or self-pay payor status (RRR 1.40, P = 0.022), medium hospital bed size (RRR 1.63, P = 0.033) and large hospital bed size (RRR 1.73, P = 0.013). There was no association between July admission and other patient or hospital demographic characteristics. Major procedures and comorbidity were significantly associated with in-hospital death, surgical and medical complications, length of hospitalization, and costs, but no association was found for July admission, July through September discharge, or teaching hospital status and short-term morbidity or mortality. Teaching hospitals and large hospital bed size were predictors of increased length of hospitalization and costs; and private, for profit hospitals were additionally associated with increased costs. No interaction between July admission and teaching hospitals was found for any of the outcome variables studied. CONCLUSIONS: These data do not support evidence of a "July effect" or an increase in morbidity or mortality at teaching hospitals providing HNCA surgical care.

Full Text

Duke Authors

Cited Authors

  • Hennessey, PT; Francis, HW; Gourin, CG

Published Date

  • August 2013

Published In

Volume / Issue

  • 123 / 8

Start / End Page

  • 1889 - 1895

PubMed ID

  • 23737378

Pubmed Central ID

  • 23737378

Electronic International Standard Serial Number (EISSN)

  • 1531-4995

International Standard Serial Number (ISSN)

  • 0023-852X

Digital Object Identifier (DOI)

  • 10.1002/lary.23884


  • eng