title: Deconstructing the "July Effect" in Operative Outcomes: A National Study.
abstract: This study analyzes the relationship between hospital teaching status, failure to rescue, and time of year in select gastrointestinal operations. Procedure codes for laparoscopic cholecystectomy, colectomy, and pancreatectomy were queried from the Nationwide Inpatient Sample (2004-2011). Failure to rescue was defined as inpatient mortality when ≥1 complication. A total of 2,777,267 laparoscopic cholecystectomies, 2,519,903 colectomies, and 129,619 pancreatectomies were performed. Teaching hospitals had increased overall rates of failure to rescue compared to non-teaching hospitals, 10.0 vs. 9.5 % (p = 0.0187), particularly between May and August. There was greater inter-month variability in non-teaching hospitals amongst individual operations. On multivariable analysis, July was not predictive of increased odds of failure to rescue. Teaching status, hospital characteristics, and patient demographics were associated with increased odds of failure to rescue. Although teaching hospitals have a higher overall failure to rescue rate amongst the selected gastrointestinal operations, odds of failure to rescue are not increased in the month of July. Non-teaching hospitals tend to exhibit more monthly variation in failure to rescue rates, and hospital/patient demographics are predictive of failure to rescue. Further investigation targeted at identifying drivers of temporal variation is warranted to optimize patient outcomes.
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA.
authors.forename: Ammara A
authors.initials: AA
authors.lastname: Watkins
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Bliss
authors.affiliation: Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Cameron
authors.forename: Mariam F
authors.initials: MF
authors.lastname: Eskander
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA. tkent@bidmc.harvard.edu.
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures; D000067248:Failure to Rescue, Health Care / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Failure to rescue; July effect; Teaching hospitals