The “July Effect” on Shoulder Arthroplasty: Are Complication Rates Higher at the Beginning of the Academic Year?

Abstract

Background: The "July effect" is a colloquialism asserting an increased rate of errors at the start of the academic<br />year in teaching hospitals. This retrospective population-based study evaluated for the presence of the July effect in<br />performing shoulder arthroplasty.<br />Methods: Using the Nationwide Inpatient Sample for 2002 through 2011, a total of 178,590 patients undergoing<br />shoulder arthroplasty at academic medical centers were identified and separated into 2 groups: 1) patients admitted<br />during July and 2) patients admitted between August and June. Multivariable logistic regression was used to identify<br />associations with inpatient mortality and adverse events, blood transfusion, prolonged length of stay (>75th percentile)<br />and non-routine discharge.<br />Results: After adjusting for patient, procedure, and hospital characteristics in multivariable modeling, admission in<br />July was not associated with increased risk for inpatient mortality (OR 1.6) aggregate morbidity, blood transfusion,<br />prolonged length of stay, and non-routine discharge.<br />Conclusion: This nationwide database analysis shows that shoulder arthroplasty at academic medical centers is not<br />associated with increased perioperative morbidity and resource utilization during the month of July.