The “July Phenomenon” for Neurosurgical Mortality and Complications in Teaching Hospitals: An Analysis of Over 850,000 Neurosurgical Patients in the Nationwide Inpatient Sample Database, 1998-2008

Kristin Jacyln Weaver, MD, PhD1, Dan Neal, PhD1, Daniel Hoh, MD1, J D. Mocco, MD1, Frederick G. Barker II, MD1, Brian Hoh, MD1

1Gainesville, FL United States

Keywords: complications, database, education, hospital, surgery

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Abstract

     The "July phenomenon" is a belief that there are worse patient outcomes in teaching hospitals during the month of July.
     The evidence for or against the presence this phenomenon in teaching hospitals has been inconsistent.
     There were 858,222 total admissions: 129,927 non-traumatic hemorrhage, 90,133 CNS trauma, 204,150 CNS tumor, and 71,687 hydrocephalus in teaching hospitals; and 91,179 non-traumatic hemorrhage, 93,757 CNS trauma, 138,328 CNS tumor, and 36,287 hydrocephalus in non-teaching hospitals
     A search of the NIS 1998-2008 was performed for all admissions for ICD-9 codes corresponding to non-traumatic hemorrhage, CNS trauma, CNS tumor, and hydrocephalus. Generalized linear mixed model analysis was performed, adjusted for gender, age, race, median income, payer; and hospital region, bed size,location, and patient volume, for the outcomes: 1) mortality, and 2) complications for the month of July compared to all other months in teaching hospitals.
     . Generalized linear mixed model analysis demonstrated that the risk of dying in the month of July versus any other month in a teaching hospital was not statistically different for any of the four diagnosis: non-traumatic hemorrhage (p=0.0706); CNS trauma (p=0.4850); CNS tumor (p=0.5775); or hydrocephalus(p=0.1505).
     This is a retrospective study.
     Moreover, the risk of any complication in the month of July versus any other month in teaching hospitals were not statistically different for any of the four diagnosis. The same findings were true in an analysis of non-teaching hospitals performed as a control.
     No July phenomenon was found for neurosurgical mortality or complications in patients with non-traumatic hemorrhage, CNS trauma, CNS tumor, or hydrocephalus.


Acknowledgements

Project Roles:

K. Weaver (), D. Neal (), D. Hoh (), J. Mocco (), F. Barker II (), B. Hoh ()