Study: ‘July phenomenon’ concerns unfounded

Editor's Note

Referred to as the “July phenomenon,” the influx of new surgical residents and interns at the beginning of the academic year is assumed to be associated with poor outcomes.

This study of nearly 1.5 million patients who had emergency general surgery either early (July-August)  or late (September-June) in the academic year found that patients managed in the early time period fared equally well, if not better, than patients managed in the later time period.

Patients managed early had marginally lower odds of mortality, complications, and developing a secondary condition. Length of stay and hospital costs were comparable between the two groups. 

Information abstracted on patient demographic, clinical case-mix, and hospital characteristics included age (categorized as 16-25, 26-35, 36-45, 46-55, 56-65, 66-75, 76-85, and >85 years), sex, race/ethnicity (categorized as non-Hispanic white, non-Hispanic black, Hispanic, non-Hispanic other, and unknown), insurance status (public, private, uninsured, and unknown), month and year of admission, NIS-defined income quartile, disease severity (All Patient Refined Diagnosis Related Group [APR-DRG] risk of mortality subclasses, ranging from 0 to 4), comorbidities (Charlson comorbidity index, categorized as 0, 1, 2, and ≥3), EGS diagnostic group (eTable 1 in the Supplement), and surgical procedure performed (eTable 2 in the Supplement).