title: The "July effect" in primary total hip and knee arthroplasty: analysis of 21,434 cases from the ACS-NSQIP database.
abstract: The "July effect" is the hypothetical increase in morbidity thought to be associated with the training of new residents during the first portion of the academic year. We evaluated for the presence of the July effect in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database among 21,434 patients who underwent primary total hip or knee arthroplasty. There was no association of an interaction term for academic quarter and resident involvement with "serious adverse events" (P = 0.656) or "any adverse events" (P = 0.578). As a result, this study could not demonstrate a July effect. Patients can be reassured that undergoing total joint arthroplasty during the first part of the academic year is without increased risk of adverse events related to the training of residents.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fu
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Golinvaux
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Gruskay
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000193:education; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000193:education; D016208:Databases, Factual; D006801:Humans; D007396:Internship and Residency; D019300:Medical Errors; D009017:Morbidity; D011183:Postoperative Complications / Q000209:etiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors
keywords: July effect; any adverse events; arthroplasty; resident education; seasonal variation; serious adverse events; total hip arthroplasty; total knee