The impact of academic calendar cycle on coronary artery bypass outcomes: a comparison of teaching and non-teaching hospitals

Journal of Cardiothoracic Surgery

John G Markley³  Tam K Dao¹  Douglas M Overbey²  Raja R Gopaldas³ 

[1] Department of Education-Psychology, University of Houston, Houston, USA;Division of Cardiothoracic Surgery, University of Missouri-Columbia, Columbia, MO, USA;Harry S. Truman VA Hospital, Suite MA 312, 65203 Columbia, MO, USA

关键词: Coronary artery bypass grafting;    Seasonal effects;    Cardiac surgery;    Academic cycle;    Failure to rescue;    July phenomenon;    July effect;   

Others  :  824019
DOI  :  10.1186/1749-8090-8-191

 received in 2013-05-11, accepted in 2013-08-27,  发布年份 2013

【 摘 要 】

Background

The commencement of new academic cycle in July is presumed to be associated with poor patient outcomes, although supportive evidence is limited for cardiac surgery patients. We sought to determine if the new academic cycle affected the outcomes of patients undergoing Coronary Artery Bypass Grafting.

Methods

A retrospective analysis was performed on 10-year nationwide in-hospital data from 1998–2007. Only patients who underwent CABG in the first and final academic 3-month calendar quarter were included. Generalized multivariate regression was used to assess indicators of hospital quality of care such as risk-adjusted mortality, total complications and “failure to rescue“ (FTOR) - defined as death after a complication.

Results

Of the 1,056,865 CABG operations performed in the selected calendar quarters, 698,942 were at teaching hospitals. The risk-adjusted mortality, complications and FTOR were higher in the beginning of the academic year [Odds ratio = 1.14, 1.04 and 1.19 respectively; p < 0.001 for all] irrespective of teaching status. However, teaching status was associated with lower mortality (OR 0.9) despite a higher complication rate (OR 1.02); [p < 0.05 for both]. The July Effect thus contributed to only a 2.4% higher FTOR in teaching hospitals compared to 19% in non teaching hospitals.

Conclusions

The July Effect is reflective of an overall increase in morbidity in all hospitals at the beginning of the academic cycle and it had a pronounced effect in non-teaching hospitals. Teaching hospitals were associated with lower mortality despite higher complication rates in the beginning of the academic cycle compared to non-teaching hospitals. The July effect thus cannot be attributed to presence of trainees alone.

Ultramini abstract

This study compares the July effect in teaching and non-teaching hospitals and demonstrates that this effect is not unique to teaching hospitals for CABG patients. In fact, teaching hospitals have somewhat better outcomes at the beginning of the academic cycle and the July effect is a much broader seasonal variation.

【 授权许可】

   
2013 Gopaldas et al.; licensee BioMed Central Ltd.

【 图 表 】

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