No 'july phenomenon' for neurosurgery patients

September 20, 2012

For patients undergoing neurosurgery at teaching hospitals, there's no "July phenomenon" of increased death and complication rates when new residents start their training, reports a study in the September issue of Neurosurgery, official journal of the Congress of Neurological Surgeons.

The risk of adverse outcomes after common brain and spinal procedures are no different in July compared to any other month, according to the research by Dr. Brian L. Hoh of University of Florida and colleagues.

Risks of Neurosurgery Don't Increase in July

To investigate whether there was a real "July phenomenon" affecting neurosurgical risks, the researchers analyzed data from a nationwide hospital database (the National Inpatient Sample) from 1998 to 2008. They focused on nearly 860,000 for four different types of common neurosurgery procedures: nontraumatic (bleeding), (CNS) trauma, CNS tumors, and hydrocephalus ("water on the brain").

For procedures performed in —where residents are involved in patient care, including surgery—rates of complications and death were compared for the month of July versus all other months. The analysis included adjustment for patient and hospital characteristics.

The results showed no significant difference in the risk of death for operations performed in July. For example, in patients undergoing surgery for CNS tumors—the largest of the four categories—the mortality rate was 7.1 percent in July compared to 7.2 percent in all other months. The was 1.4 percent in July and in all other months.

Death and complication rates were also similar for July versus other months in the other three diagnostic categories. Analysis of patients treated at non-teaching hospitals—which don't train residents—also showed no significant differences in mortality or complications rates.

Previous studies have evaluated whether there is any evidence of a "July phenomenon" in various medical specialties. The results have been inconsistent, although most studies have found no difference in at the start of the academic year in July—when new graduates start residency training and current residents take on increased responsibilities. The new study is one of the few to look at whether there is any difference in the outcomes of common procedures related to the "July phenomenon."

Based on their large, nationwide study, Dr. Hoh and colleagues conclude, "No 'July phenomenon' was found for neurosurgical mortality or complications in patients with nontraumatic hemorrhage, CNS trauma, CNS tumor, or hydrocephalus." The researchers acknowledge some weaknesses of their study—particularly the fact that it couldn't detect "near-miss" errors that don't lead to death or serious complications. They also note, "The lack of a July phenomenon may be attributable to the increased supervision by faculty and more senior residents during the start of the academic year."

Explore further: Patients at teaching hospitals don't fare worse with trainee doctors, research shows

Related Stories

Patients at teaching hospitals don't fare worse with trainee doctors, research shows

September 20, 2012
(Medical Xpress)—A University of Florida physician and colleagues have "mythbusted" a notion long held in medical circles: patients at teaching hospitals fare worse in July when new medical graduates start their residency ...

Surgeon experience affects complication rate of spinal stenosis surgery

June 7, 2012
For patients undergoing surgery for spinal stenosis, the risk of complications is higher when the surgeon performs very few such procedures—less than four per year, suggests a study in the June issue of Neurosurgery, ...

Researchers evaluate impact of July effect in teaching hospitals

July 13, 2011
(Medical Xpress) -- UCSF researchers have conducted the first major review of research on the “July effect,” a theory that the quality of health care at teaching hospitals declines during the month of July ...

Recommended for you

Smoking raises risk of aneurysm recurrence after endovascular treatment

August 17, 2017
In a new study, researchers report people who have experienced an aneurysm have another reason to quit smoking.

Study adds to evidence that most prescribed opioid pills go unused

August 2, 2017
In a review of half a dozen published studies in which patients self-reported use of opioids prescribed to them after surgery, researchers at Johns Hopkins report that a substantial majority of patients used only some or ...

Engineers harness the power of 3-D printing to help train surgeons, shorten surgery times

August 2, 2017
A team of engineers and pediatric orthopedic surgeons are using 3D printing to help train surgeons and shorten surgeries for the most common hip disorder found in children ages 9 to 16. In a recent study, researchers showed ...

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.