title: "July effect" in elective spine surgery: analysis of the American College of Surgeons National Surgical Quality Improvement Program database.
abstract: METHODS
  Retrospective cohort.
  
  
  OBJECTIVE
  To evaluate for the presence and magnitude of the "July effect" within elective spine surgery.
  
  
  BACKGROUND
  The July effect is the hypothetical increase in morbidity and mortality thought to be associated with the influx of new (or newly promoted) trainees during the first portion of the academic year. Studies evaluating for the presence and magnitude of the July effect have demonstrated conflicting results.
  
  
  METHODS
  We accessed the American College of Surgeons National Surgical Quality Improvement Program database from 2005-2010. Statistical analyses were conducted using bivariate and multivariate logistic regression.
  
  
  RESULTS
  A total of 14,986 cases met inclusion criteria and constitute the study population. Of these, 26.5% occurred in the first academic quarter and 25.3% had resident involvement. The rate of serious adverse events was 1.9 times higher and the rate of any adverse events was 1.6 times higher among cases with resident involvement than among those without (P < 0.001 for both). Among cases without resident involvement, the rates of serious adverse events and any adverse events did not differ by academic quarter. Similarly, among cases with resident involvement, the rates of serious adverse events and any adverse events did not differ by academic quarter.
  
  
  CONCLUSIONS
  We could not demonstrate that the training of new (or newly promoted) residents is associated with an increase in the adverse events of spine surgery. Safeguards that have been put in place to ensure patient safety during this training period seem to be effective. Although adverse events were more common among cases with resident involvement than among cases without resident involvement, our data suggest that this association is more likely a product of the riskier population of cases in which residents participate than of the resident involvement itself.
authors.affiliation: From the Yale School of Medicine, New Haven, CT.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fu
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Gruskay
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Golinvaux
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D002983:Clinical Competence; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D058996:Quality Improvement; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*; D013997:Time Factors; D014481:United States