Is There Evidence of a July Effect among Patients Undergoing Hysterectomy Surgery?

It has been hypothesized that yearly turnover and hospitals' overall transition from more experienced to less experienced trainees from July to September may be responsible for an increase in medical errors and poorer outcomes, a phenomenon known as the July effect. A large number of studies have investigated the July effect in both medical and surgical fields, but results have been largelymixed. Very few studies have explored the July effect in obstetrics and gynecology or for specific gynecologic procedures. This retrospective study systematically examined hysterectomy outcomes in the state of Maryland during the 3-month period from July through September as compared with all other months of the academic year to assess the presence of a July effect in hysterectomy surgery. Data were obtained from Maryland Health Services Cost Review Commission Database from July 2012 through September 2015. The study focused on hysterectomies performed either by obstetricians and gynecologists or gynecologic oncologists, from July through September versus October through June. Multivariable logistic regression was used to account for clustering by hospitals, adjusting for several covariates. The primary study outcome was the presence of at least 1 of 11 in-hospital complications; secondary outcomes were extended postoperative length of stay (defined as >2 days) and 30-day inpatient readmission rates. A total of 6311 hysterectomies were identified (78.2% for benign conditions) performed by surgeons at 20 academic hospitals. Forty-three percent of patients were white, 54.4% were between 45 and 64 years old, and 66.3% had private insurance. Overall, the unadjusted rate of in-hospital complications was 16.8%, extended length of stay was 30.3%, and 30-day readmissions were 6.6%. Logistic regression analysis showed that patients undergoing hysterectomies from July through September had no more adverse outcomes compared with those undergoing surgery at other times of the year: complications (adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.75-1.01), length of stay for more than 2 days (aOR, 1.03; 95% CI, 0.90-1.19), and 30-day readmissions (aOR, 0.99; 95% CI, 0.80-1.23). Several sensitivity analyses assessing individual complications, hysterectomy outcomes at nonacademic hospitals, and benign versus malignant indications for hysterectomies had similar results. This study found no evidence that women inMaryland undergoing hysterectomy surgery at academic hospitals during July through September have worse outcomes compared with women having surgery in other months. Further studies are needed to assess the possibility of a July effect in hysterectomy on a national basis. Patient safety and outcomes should be a priority for all institutions training the next generation of new interns and residents transitioning to more senior roles.