No 'July phenomenon' for neurosurgery patients, reports Neurosurgery

(Press-News.org) Philadelphia, Pa. (September 20, 2012) – For patients undergoing neurosurgery at teaching hospitals, there's no "July phenomenon" of increased death and complication rates when new residents start their training, reports a study in the September issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The risk of adverse outcomes after common brain and spinal procedures are no different in July compared to any other month, according to the research by Dr. Brian L. Hoh of University of Florida and colleagues.

Risks of Neurosurgery Don't Increase in July To investigate whether there was a real "July phenomenon" affecting neurosurgical risks, the researchers analyzed data from a nationwide hospital database (the National Inpatient Sample) from 1998 to 2008. They focused on nearly 860,000 hospital admissions for four different types of common neurosurgery procedures: nontraumatic brain hemorrhage (bleeding), central nervous system (CNS) trauma, CNS tumors, and hydrocephalus ("water on the brain").

For procedures performed in teaching hospitals—where residents are involved in patient care, including surgery—rates of complications and death were compared for the month of July versus all other months. The analysis included adjustment for patient and hospital characteristics.

The results showed no significant difference in the risk of death for operations performed in July. For example, in patients undergoing surgery for CNS tumors—the largest of the four categories—the mortality rate was 7.1 percent in July compared to 7.2 percent in all other months. The complication rate was 1.4 percent in July and in all other months.

Death and complication rates were also similar for July versus other months in the other three diagnostic categories. Analysis of patients treated at non-teaching hospitals—which don't train residents—also showed no significant differences in mortality or complications rates.

Previous studies have evaluated whether there is any evidence of a "July phenomenon" in various medical specialties. The results have been inconsistent, although most studies have found no difference in at the start of the academic year in July—when new graduates start residency training and current residents take on increased responsibilities. The new study is one of the few to look at whether there is any difference in the outcomes of common neurosurgery procedures related to the "July phenomenon."

Based on their large, nationwide study, Dr. Hoh and colleagues conclude, "No 'July phenomenon' was found for neurosurgical mortality or complications in patients with nontraumatic hemorrhage, CNS trauma, CNS tumor, or hydrocephalus." The researchers acknowledge some weaknesses of their study—particularly the fact that it couldn't detect "near-miss" errors that don't lead to death or serious complications. They also note, "The lack of a July phenomenon may be attributable to the increased supervision by faculty and more senior residents during the start of the academic year."

### About Neurosurgery Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).