AANS Neurosurgeon | Volume 27, Number 2, 2018


Little or No “July Effect” in Neurosurgery

The “July effect” is the theory that more medical and surgical errors, and, consequently, greater levels of morbidity and mortality occur during July, the month during which fourth year medical students become interns and residents advance to higher levels of training where they face greater challenges and more responsibility. There is debate as to whether the July effect exists in neurosurgery and, if so, to what extent. The findings, published in the Journal of Neurosurgery, examined data from neurosurgical cases managed between 2006 and 2012. Researchers from Columbia University, New York University and the University of Pittsburgh included 16,343 cases managed in academic medical centers, where residents were part of the surgical team, and 20,792 cases managed at community-based hospitals, where no residents were involved. The data were obtained from one of the largest prospective medical databases — the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database — which contains data on 30-day morbidity and mortality as well as a wide variety of other postoperative outcomes. In general, the overall results showed no significant differences in neurosurgical patient outcomes in academic medical centers between Q1 and Q4 with respect to mortality, medical complications or mild complications. The authors reported no clear evidence for decreased efficiency during Q1, as compared with Q4. The authors also looked at postoperative mortality and complications among neurosurgical patients treated at community-based hospitals for the same yearly quarters and found no significant differences in mortality or complications between Q1 and Q4. To read more about this study, click here.

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