The "July effect": Outcomes in microvascular reconstruction during resident transitions.

[OBJECTIVES/HYPOTHESIS] To evaluate the "July effect," as a possible risk factor for perioperative complications in otolaryngology microvascular reconstruction during the transitional period in the academic calendar.

[STUDY DESIGN] Retrospective database review.

[METHODS] Microvascular reconstruction outcomes in the National Surgical Quality Improvement Program (2005-2016) database were compared between the first academic quarter (July-September) to the last academic quarter (April-June). The primary outcome was 30-day morbidity, and secondary outcomes included 30-day mortality, operative complications, or postoperative adverse events.

[RESULTS] There were 612 and 580 patients who underwent microvascular reconstruction during the first and last academic quarters, respectively. There was no significant difference between the 30-day mortality between the first academic quarter (1.5%) and the last academic quarter (0.7%) (P = .194). There was no difference in 30-day morbidity (47.9% vs. 49.5%, P = .586), operative complications (wound disruption, P = .151; bleeding, P = .526; operative time, P = .162), or postoperative adverse events (deep vein thrombosis, P = .460; pneumonia, P = .737; reintubation, P = .201; pulmonary embolism, P = .452; ventilation for >48 hours, P = .769; acute renal failure, P = .500; urinary tract infection, P = .693; unplanned readmission, P = .202; and mean length of stay, P = .497).

[CONCLUSIONS] There appears to be no July effect in microvascular reconstruction. Further studies should identify the mechanisms that preserve the safety of this operation year-round for application to other areas of medicine who have observed the July effect.

[LEVEL OF EVIDENCE] NA Laryngoscope, 130:893-898, 2020.