"July Effect" Revisited: July Surgeries at Residency Training Programs are Associated with Equivalent Long-term Clinical Outcomes Following Lumbar Spondylolisthesis Surgery.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Jun 2021
15 Jun 2021
Historique:
pubmed:
5
1
2021
medline:
7
7
2021
entrez:
4
1
2021
Statut:
ppublish
Résumé
Retrospective analysis of a prospective registry. We utilized the Quality Outcomes Database (QOD) registry to investigate the "July Effect" at QOD spondylolisthesis module sites with residency trainees. There is a paucity of investigation on the long-term outcomes following surgeries involving new trainees utilizing high-quality, prospectively collected data. This was an analysis of 608 patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Surgeries were classified as occurring in July or not in July (non-July). Outcomes collected included estimated blood loss, length of stay, operative time, discharge disposition, complications, reoperation and readmission rates, and patient-reported outcomes (Oswestry Disability Index [ODI], Numeric Rating Scale [NRS] Back Pain, NRS Leg Pain, EuroQol-5D [EQ-5D] and the North American Spine Society [NASS] Satisfaction Questionnaire). Propensity score-matched analyses were utilized to compare postoperative outcomes and complication rates between the July and non-July groups. Three hundred seventy-one surgeries occurred at centers with a residency training program with 21 (5.7%) taking place in July. In propensity score-matched analyses, July surgeries were associated with longer operative times ( average treatment effect = 22.4 minutes longer, 95% confidence interval 0.9-449.0, P = 0.041). Otherwise, July surgeries were not associated with significantly different outcomes for the remaining perioperative parameters (estimated blood loss, length of stay, discharge disposition, postoperative complications), overall reoperation rates, 3-month readmission rates, and 24-month ODI, NRS back pain, NRS leg pain, EQ-5D, and NASS satisfaction score (P > 0.05, all comparisons). Although July surgeries were associated with longer operative times, there were no associations with other clinical outcomes compared to non-July surgeries following lumbar spondylolisthesis surgery. These findings may be due to the increased attending supervision and intraoperative education during the beginning of the academic year. There is no evidence that the influx of new trainees in July significantly affects long-term patient-centered outcomes.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective analysis of a prospective registry.
OBJECTIVE
OBJECTIVE
We utilized the Quality Outcomes Database (QOD) registry to investigate the "July Effect" at QOD spondylolisthesis module sites with residency trainees.
SUMMARY OF BACKGROUND DATA
BACKGROUND
There is a paucity of investigation on the long-term outcomes following surgeries involving new trainees utilizing high-quality, prospectively collected data.
METHODS
METHODS
This was an analysis of 608 patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Surgeries were classified as occurring in July or not in July (non-July). Outcomes collected included estimated blood loss, length of stay, operative time, discharge disposition, complications, reoperation and readmission rates, and patient-reported outcomes (Oswestry Disability Index [ODI], Numeric Rating Scale [NRS] Back Pain, NRS Leg Pain, EuroQol-5D [EQ-5D] and the North American Spine Society [NASS] Satisfaction Questionnaire). Propensity score-matched analyses were utilized to compare postoperative outcomes and complication rates between the July and non-July groups.
RESULTS
RESULTS
Three hundred seventy-one surgeries occurred at centers with a residency training program with 21 (5.7%) taking place in July. In propensity score-matched analyses, July surgeries were associated with longer operative times ( average treatment effect = 22.4 minutes longer, 95% confidence interval 0.9-449.0, P = 0.041). Otherwise, July surgeries were not associated with significantly different outcomes for the remaining perioperative parameters (estimated blood loss, length of stay, discharge disposition, postoperative complications), overall reoperation rates, 3-month readmission rates, and 24-month ODI, NRS back pain, NRS leg pain, EQ-5D, and NASS satisfaction score (P > 0.05, all comparisons).
CONCLUSION
CONCLUSIONS
Although July surgeries were associated with longer operative times, there were no associations with other clinical outcomes compared to non-July surgeries following lumbar spondylolisthesis surgery. These findings may be due to the increased attending supervision and intraoperative education during the beginning of the academic year. There is no evidence that the influx of new trainees in July significantly affects long-term patient-centered outcomes.Level of Evidence: 3.
Identifiants
pubmed: 33394990
doi: 10.1097/BRS.0000000000003903
pii: 00007632-202106150-00012
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
836-843Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Rihn JA, Hilibrand AS, Zhao W, et al. Effectiveness of surgery for lumbar stenosis and degenerative spondylolisthesis in the octogenarian population: analysis of the Spine Patient Outcomes Research Trial (SPORT) data. J Bone Joint Surg Am 2015; 97:177.
Karsy M, Bisson EF. Surgical versus nonsurgical treatment of lumbar spondylolisthesis. Neurosurg Clin 2019; 30:333–340.
Kalichman L, Kim DH, Li L, et al. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976) 2009; 34:199.
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 2007; 356:2257–2270.
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis: four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 2009; 91:1295.
Deyo RA, Gray DT, Kreuter W, et al. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 2005; 30:1441–1445.
Cameron JL. William Stewart Halsted. Our surgical heritage. Ann Surg 1997; 225:445.
Shah RM, Hirji SA, Kiehm S, et al. Debunking the July effect in cardiac surgery: a national analysis of more than 470,000 procedures. Ann Thorac Surg 2019; 108:929–934.
Zafar SN, Shah AA, Hashmi ZG, et al. Outcomes after emergency general surgery at teaching versus nonteaching hospitals. J Trauma Acute Care Surg 2015; 78:69–77.
McDonald JS, Clarke MJ, Helm GA, et al. The effect of July admission on inpatient outcomes following spinal surgery. J Neurosurg Spine 2013; 18:280–288.
Dasenbrock HH, Clarke MJ, Thompson RE, et al. The impact of July hospital admission on outcome after surgery for spinal metastases at academic medical centers in the United States, 2005 to 2008. Cancer 2012; 118:1429–1438.
De la Garza-Ramos R, Passias PG, Schwab FJ, et al. The effect of July admission on inpatient morbidity and mortality after adult spinal deformity surgery. Int J Spine Surg 2016; 10:3.
Hoashi JS, Samdani AF, Betz RR, et al. Is there a “July effect” in surgery for adolescent idiopathic scoliosis? J Bone Joint Surg Am 2014; 96:e55.
Nandyala SV, Marquez-Lara A, Fineberg SJ, et al. Perioperative characteristics and outcomes of patients undergoing anterior cervical fusion in July: analysis of the “July effect”. Spine (Phila Pa 1976) 2014; 39:612–617.
Bohl DD, Fu MC, Gruskay JA, et al. July effect” in elective spine surgery: analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Spine (Phila Pa 1976) 2014; 39:603–611.
Bohl DD, Russo GS, Basques BA, et al. Variations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures. J Boint Joint Surg Am 2014; 96:e193.
McGirt MJ, Speroff T, Dittus RS, et al. The National Neurosurgery Quality and Outcomes Database (N2QOD): general overview and pilot-year project description. Neurosurg Focus 2013; 34:E6.
Chan AK, Bisson EF, Bydon M, et al. Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database. Neurosurg Focus 2018; 44:E3.
Chan AK, Bisson EF, Bydon M, et al. A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis. Neurosurg Focus 2019; 46:E13.
Asher AL, Kerezoudis P, Mummaneni PV, et al. Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database. Neurosurg Focus 2018; 44:E2.
Chan AK, Bisson EF, Bydon M, et al. Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg: Spine 2018; 30:234–241.
Fairbank JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976) 2000; 25:2940–2953.
Group TE. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 1990; 16:199–208.
Daltroy LH, Cats-Baril WL, Katz JN, et al. The North American spine society lumbar spine outcome assessment Instrument: reliability and validity tests. Spine (Phila Pa 1976) 1996; 21:741–748.
Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain 1994; 58:387–392.
Gruskay J, Smith J, Kepler CK, et al. The seasonality of postoperative infection in spine surgery. J Neurosurg Spine 2013; 18:57–62.
Lieber BA, Appelboom G, Taylor BE, et al. Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery. J Neurosurg 2016; 125:213–221.
Lin Y, Mayer RR, Verla T, et al. Is there a “July effect” in pediatric neurosurgery? Childs Nerv Syst 2017; 33:1367–1371.
Auerbach JD, Lonner BS, Antonacci MD, et al. Perioperative outcomes and complications related to teaching residents and fellows in scoliosis surgery. Spine (Phila Pa 1976) 2008; 33:1113–1118.
Phan K, Phan P, Stratton A, et al. Impact of resident involvement on cervical and lumbar spine surgery outcomes. Spine J 2019; 19:1905–1910.
Kothari P, Lee NJ, Lakomkin N, et al. Impact of resident involvement on morbidity in adult patients undergoing fusion for spinal deformity. Spine (Phila Pa 1976) 2016; 41:1296–1302.
Lee NJ, Kothari P, Kim C, et al. The impact of resident involvement in elective posterior cervical fusion. Spine (Phila Pa 1976) 2018; 43:316–323.
Kim RB, Garcia RM, Smith ZA, et al. Impact of resident participation on outcomes after single-level anterior cervical diskectomy and fusion: an analysis of 3265 patients from the American College of Surgeons National Surgical Quality Improvement Program Database. Spine (Phila Pa 1976) 2016; 41:E289–E296.
Yamaguchi JT, Garcia RM, Cloney MB, et al. Impact of resident participation on outcomes following lumbar fusion: An analysis of 5655 patients from the ACS-NSQIP database. J Clin Neurosci 2018; 56:131–136.
Bydon M, Abt NB, De la Garza-Ramos R, et al. Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16098 patients. J Neurosurg 2015; 122:955–961.
Seicean A, Kumar P, Seicean S, et al. Impact of resident involvement in neurosurgery: an American College of Surgeons’ National Surgical Quality Improvement Program database analysis of 33,977 patients. Neurospine 2018; 15:54.
Fallon JW, Wears RL. Resident supervision in the operating room: does this impact on outcome? J Trauma 1993; 35:556–560. discussion 60-1.
Banco SP, Vaccaro AR, Blam O, et al. Spine infections: variations in incidence during the academic year. Spine (Phila Pa 1976) 2002; 27:962–965.
Farnan JM, Petty LA, Georgitis E, et al. A systematic review: the effect of clinical supervision on patient and residency education outcomes. Acad Med 2012; 87:428–442.
Karhade AV, Larsen AM, Cote DJ, et al. National databases for neurosurgical outcomes research: options, strengths, and limitations. Neurosurgery 2018; 83:333–344.
Mummaneni PV, Bisson EF, Kerezoudis P, et al. Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: analysis of the Quality Outcomes Database. Neurosurg Focus 2017; 43:E11.
Mannion AF, Junge A, Elfering A, et al. Great expectations: really the novel predictor of outcome after spinal surgery? Spine (Phila Pa 1976) 2009; 34:1590–1599.
Soroceanu A, Ching A, Abdu W, et al. Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study. Spine (Phila Pa 1976) 2012; 37:E103–E108.