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Is there a "July Effect" within Plastic Surgery?
Demetrius M. Coombs, M.D.; Mustafa S. Ascha, M.S.; Mona Ascha, M.D.; James Gatherwright, M.D.; Rebecca Knackstedt, M.D., Ph.D.; Raffi Gurunluoglu, M.D., Ph.D
Department of Plastic Surgery, the Cleveland Clinic; Center for Clinical Investigation, Department o
2018-02-10
Presenter: Coombs
Affidavit:
The aforementioned work represents the work of the residents as indicated in the authors' section.
Director Name: Steven Bernard, M.D.
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: The "July Effect" represents a topic of considerable interest across residency programs. This study investigated post-operative complication rates following procedures with plastic surgery resident participation (all PGY levels) during the first and last academic quarters.
Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was used to calculate complication rates from 2006-2010. Resident involvement was analyzed as a categorical variable consisting of "juniors" (PGY1-PGY3) and "seniors" (PGY4-PGY8) during cosmetic and reconstructive procedures, exclusively cosmetic, and exclusively reconstructive.
Results: Among all cosmetic and reconstructive procedures (n = 7483), mean operative time was significantly greater in Q3 (July-September) compared to all other quarters. Among reconstructive procedures only (n = 6394), mean operative time was significantly greater in Q3 (p=0.042); superficial surgical site infection was also significantly more likely to occur in Q3 versus all other quarters (p=0.021). Odds ratios comparing superficial surgical site infection and return to the operating room, and adjusting for PGY status and matching populations, demonstrated that neither were significantly more common in Q3. When adjusting for quarter of admission and matching populations, superficial surgical site infection was significantly more common among both cosmetic and reconstructive procedures, cosmetic procedures alone, and reconstructive procedures alone, with participation by juniors (p=0.007).
Conclusion:This is the first study to demonstrate that while "timing" is not significantly associated with increased complications, a "July Effect" appears to manifest itself in the absence of senior residents, and bears consideration for both the cosmetic and reconstructive aspects of residency training.
