Absence of a "July Effect" on Hospital Length of Stay After Primary Total Hip or Knee Arthroplasty.
Academic Article
Overview
abstract
There is a commonly held belief in a "July effect" resulting in suboptimal outcomes as residents begin or advance in their training each summer. Previous studies have shown an absence of a July effect on clinical outcomes after total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, it remains unknown whether there is a July effect on hospital length of stay (LOS) after primary THA/TKA. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried from 2006 to 2012 for cases of primary THA/TKA, excluding emergency cases or cases where the ATTEND variable indicating resident participation was coded as missing or unknown. The primary outcome was prolonged LOS, defined as greater than 4 days postoperative. Secondary outcomes, including mortality, unplanned return to the operating room, and adverse clinical events, were also recorded. Univariate and multivariate analyses, including correction for comorbidities, evaluated associations between resident involvement in a case and any outcomes, and whether this association was different in quarter 3 (July through September) vs the remainder of the year. A total of 34,818 cases were included. Residents were involved in 9669 (28%). Length of stay greater than 4 days occurred in 12% of resident cases overall vs 11% of non-resident cases. Quarter 3 also had significantly more cases with prolonged LOS (12%) vs quarters 1 and 2 and quarter 4 (all 11%). On multivariate analysis, the resident effect on LOS greater than 4 days remained significant during the entire year; however, resident involvement in quarter 3 was not associated with prolonged LOS. These results do not support the presence of a July effect on LOS after primary THA/TKA. [Orthopedics. 2021;44(4):e503-e508.].
