The “July Effect” Does Not Have Clinical Relevance in Liver Transplantation

In the beginning of the academic year, medical errors are often attributed to inexperienced medical staff. This potential seasonal influence on health care outcomes is termed the “July effect.” No study has demonstrated the July effect in liver transplantation. We reviewed retrospectively collected...

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Bibliographic Details
Published in:Journal of surgical education 2013-09, Vol.70 (5), p.669-679
Main Authors: Karipineni, Farah, MD, Panchal, Hinaben, MD, Khanmoradi, Kamran, MD, Parsikhia, Afshin, MD, Ortiz, Jorge, MD
Format: Article
Language:English
Subjects:
Adult
Clinical Competence
End Stage Liver Disease - mortality
End Stage Liver Disease - surgery
errors
Female
General Surgery - education
Graft Survival
house staff
Humans
Internship and Residency - organization & administration
Internship and Residency - statistics & numerical data
July
Kaplan-Meier Estimate
Liver Transplantation - mortality
Medical Errors - statistics & numerical data
Medical Knowledge
Middle Aged
Outcome Assessment (Health Care)
Practice-Based Learning and Improvement
Severity of Illness Index
Surgery
survival
Systems-Based Practice
transplant
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Summary:In the beginning of the academic year, medical errors are often attributed to inexperienced medical staff. This potential seasonal influence on health care outcomes is termed the “July effect.” No study has demonstrated the July effect in liver transplantation. We reviewed retrospectively collected data from the United Network for Organ Sharing for patients who underwent liver transplantation from October 1987 to June 2011 to determine if surgical outcomes were worse in July compared with rest of the year. We found no clinical difference in early graft survival (91.11% vs 90.72%, p = 0.045) and no difference in early patient survival (94.71% vs 94.42%, p = 0.057). Survival at 1 year, 3 years, and 5 years was also compared and no notable differences were detected. Because the Model for End-stage Liver Disease (MELD) score implementation in 2002 affected the acuity of liver transplant recipients, we further stratified our data to compare pre- and post-MELD survival to remove subjectivity as a confounding factor. MELD stratification revealed no seasonal difference in outcomes. There was no difference in rate of graft failure and acute and chronic rejection between groups. Our findings show no evidence of the July effect in liver transplantation. Each July, thousands of medical residents take on new responsibilities in patient care. It has been suggested that these new practitioners may produce errors that contribute to worse patient outcomes in the beginning of the academic year—a phenomenon called the “July effect.” Currently, there are few research studies with controversial evidence of poorer outcomes in July, and no articles address the effect of new medical staff in the setting of liver transplantation. Our study compares short-, medium-, and long-term graft and patient survival between July and August and the remaining months using national data. We also examine survival before and after the implementation of the MELD scoring system to determine its effect on outcomes in the beginning of the academic year.
ISSN:1931-7204
1878-7452
DOI:10.1016/j.jsurg.2013.04.012