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

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

Keywords:

Complications , July effect , Nationwide inpatient sample , Resident education , Shoulder Arthroplasty , Teaching hospitals