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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 academic year in teaching hospitals. This retrospective population-based study evaluated for the presence of the July effect in performing shoulder arthroplasty.


Methods
Using the Nationwide Inpatient Sample for 2002 through 2011, a total of 178,590 patients undergoing shoulder arthroplasty at academic medical centers were identified and separated into 2 groups: 1) patients admitted during July and 2) patients admitted between August and June. Multivariable logistic regression was used to identify associations 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 in July 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 not associated with increased perioperative morbidity and resource utilization during the month of July.