BACKGROUND AND PURPOSE: 

• There is speculation that due to resident turnover, there may be more hysterectomy complications between the months of July to September 
• Data is mixed  
  • Even in studies where this effect is seen, there is no evidence a to causation  
• Varma et al. (AJOG, 2018) studied whether hysterectomy quality decreases during annual trainee turnover in July

METHODS: 

• Retrospective Statewide Study / Database review  
  • Maryland Health Services Cost Review Commission Database, “one of the most robust surgical statewide registries in the United States” 
  • Hysterectomy for different gynecologic and obstetric causes throughout different times of the year  
• Primary outcome: At least 1 of 11 major perioperative in-hospital complications, including  
  • Acute renal failure | Respiratory failure | Surgical site infection | Gastrointestinal bleed | Pneumonia | Hemorrhage | Myocardial infarction | DVT/PE | Pelvic abscess | Blood transfusion | Bowel obstruction 
• Secondary outcomes  
  • Extended postoperative length of stay (defined as >2 days) | 30-day inpatient readmission rates

RESULTS: 

• 6311 hysterectomies were included 
  • Performed by various surgeons and hospitals 
  • 78.2% hysterectomies were benign  
  • Patients were primarily white (42.8%), 45–64 years old (54.4%), and had private insurance (66.3%) 
• Patients undergoing hysterectomies during July through September did not have more adverse outcomes relative to those undergoing surgery at other times of the year complications  
  • Adverse outcomes: Adjusted odds ratio (OR) 0.87; 95% CI 0.75–1.01 
  • Length of stay >2 days: Adjusted OR 1.03; 95% CI 0.90–1.19 
  • 30-day readmissions: Adjusted OR 0.99; 95% confidence interval, 0.80–1.23 
• Hysterectomy outcomes at nonacademic hospitals, and benign vs. malignant indications for hysterectomies yielded similar findings

CONCLUSION: 

• Patients were not more likely to suffer adverse outcomes following hysterectomy, for benign or malignant conditions, during periods of trainee turnover

Learn More – Primary Sources: 

Is there evidence of a July effect among patients undergoing hysterectomy surgery?

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