title: Is there any evidence of a "July effect" in patients undergoing major cancer surgery?
abstract: BACKGROUND
  The "July effect" refers to the phenomenon of adverse impacts on patient care arising from the changeover in medical staff that takes place during this month at academic medical centres in North America. There has been some evidence supporting the presence of the July effect, including data from surgical specialties. Uniformity of care, regardless of time of year, is required for patients undergoing major cancer surgery. We therefore sought to perform a population-level assessment for the presence of a July effect in this field.
  
  
  METHODS
  We used the Nationwide Inpatient Sample to abstract data on patients undergoing 1 of 8 major cancer surgeries at academic medical centres between Jan. 1, 1999, and Dec. 30, 2009. The primary outcomes examined were postoperative complications and in-hospital mortality. Univariate analyses and subsequently multivariate analyses, controlling for patient and hospital characteristics, were performed to identify whether the time of surgery was an independent predictor of outcome after major cancer surgery.
  
  
  RESULTS
  On univariate analysis, the overall postoperative complication rate, as well as genitourinary and hematologic complications specifically, was higher in July than the rest of the year. However, on multivariate analysis, only hematologic complications were significantly higher in July, with no difference in overall postoperative complication rate or in-hospital mortality for all 8 surgeries considered separately or together.
  
  
  CONCLUSIONS
  On the whole, the data confirm an absence of a July effect in patients undergoing major cancer surgery.
authors.affiliation: The Center for Outcomes Research and Analytics, Vattikuti Urology Institute, Detroit, Mich.
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.affiliation: The Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, University of Montreal, Montréal, Que.
authors.forename: Vincent Q
authors.initials: VQ
authors.lastname: Trinh
authors.affiliation: The Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, University of Montreal, Montréal, Que.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: The Center for Outcomes Research and Analytics, Vattikuti Urology Institute, Detroit, Mich.
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.affiliation: The Center for Outcomes Research and Analytics, Vattikuti Urology Institute, Detroit, Mich.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: The Department of Surgery, Division of General Surgery, University of Montreal, Montréal, Que.
authors.forename: Mai-Kim
authors.initials: MK
authors.lastname: Gervais
authors.affiliation: The Department of Urology, Weill Medical College of Cornell University, New York, NY.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: The Department of Urology, Mayo Clinic, Rochester, Minn.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: The Department of Urology, Georgetown University Hospital, Washington, DC.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.affiliation: The Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Calif.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: The Center for Outcomes Research and Analytics, Vattikuti Urology Institute, Detroit, Mich.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: The Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, University of Montreal, Montréal, Que.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: The Center for Outcomes Research and Analytics, Vattikuti Urology Institute, Detroit, Mich. and the Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, University of Montreal, Montréal, Que.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D009656:North America; D010507:Periodicity; D010561:Personnel Staffing and Scheduling; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors