Debunking the July Effect in Transcatheter Interventions in Structural Heart Disease: Truth or Myth?
Clinical training
July effect
MitraClip
Outcomes
TAVR
Journal
Structural heart : the journal of the Heart Team
ISSN: 2474-8714
Titre abrégé: Struct Heart
Pays: United States
ID NLM: 101743256
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
25
07
2021
revised:
07
10
2021
accepted:
24
11
2021
medline:
17
3
2022
pubmed:
17
3
2022
entrez:
5
6
2023
Statut:
epublish
Résumé
The "July effect", the perception of worse outcomes in the first month of training, has been previously demonstrated in critical care medicine and general surgery. However, the July effect in the context of structural heart interventions (i.e., transcatheter aortic valve replacement [TAVR] and MitraClip) remains unknown. All adult patients undergoing TAVR or MitraClip in the 2012-2016 National Inpatient Sample were included. Outcomes were compared by procedure month and academic year quartiles (i.e., between the first academic year quartile [Q1] vs. the fourth quartile [Q4]). Outcomes between teaching and nonteaching hospitals were compared using risk-adjusted logistic difference-in-difference regression. During the study period, 94,170 TAVR (Q1: 25,250; Q4: 23,170) and 8750 MitraClip (Q1: 2220; Q4: 2150) procedures were performed. In-hospital mortality did not vary as per academic year quartiles for either procedure, even after risk adjustment. These findings persisted in sensitivity analysis by procedure month and newer device era (2015-2016; all In this large, nationwide study, the July effect was not evident for structural heart interventions. With increasing interest and growth in transcatheter procedures, early resident and fellow teaching can be achieved with appropriate supervision.
Sections du résumé
Background
UNASSIGNED
The "July effect", the perception of worse outcomes in the first month of training, has been previously demonstrated in critical care medicine and general surgery. However, the July effect in the context of structural heart interventions (i.e., transcatheter aortic valve replacement [TAVR] and MitraClip) remains unknown.
Methods
UNASSIGNED
All adult patients undergoing TAVR or MitraClip in the 2012-2016 National Inpatient Sample were included. Outcomes were compared by procedure month and academic year quartiles (i.e., between the first academic year quartile [Q1] vs. the fourth quartile [Q4]). Outcomes between teaching and nonteaching hospitals were compared using risk-adjusted logistic difference-in-difference regression.
Results
UNASSIGNED
During the study period, 94,170 TAVR (Q1: 25,250; Q4: 23,170) and 8750 MitraClip (Q1: 2220; Q4: 2150) procedures were performed. In-hospital mortality did not vary as per academic year quartiles for either procedure, even after risk adjustment. These findings persisted in sensitivity analysis by procedure month and newer device era (2015-2016; all
Conclusions
UNASSIGNED
In this large, nationwide study, the July effect was not evident for structural heart interventions. With increasing interest and growth in transcatheter procedures, early resident and fellow teaching can be achieved with appropriate supervision.
Identifiants
pubmed: 37273471
doi: 10.1016/j.shj.2022.100001
pii: S2474-8706(22)00001-X
pmc: PMC10236779
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100001Informations de copyright
© 2022 The Author(s).
Déclaration de conflit d'intérêts
C.K.Z. is supported by 10.13039/100000002NIH Medical Scientist Training Program Training Grant T32GM007205. She is the PI of an F30 award through the National Institute on Aging F30AG066371 entitled “The ED.TRAUMA Study: Evaluating the Discordance of Trauma Readmission And Unanticipated Mortality in the Assessment of hospital quality.” M.J.R. served as a study investigator, a consultant, and a proctor for Edwards Lifesciences, Boston Scientific, and Abbott. P.O. has been a consultant to Medtronic and Edwards Lifesciences. P.S. reports receiving compensation as a proctor for Edwards and educational grants from Edwards, Medtronic, and Abbott. He also reports that his wife is an employee of Thermo Fisher. T.K. is a speaker for Edwards Life Sciences, Medtronic, Abbott, and Baylis Medical and is a consultant for 4C Medical. There are no other potential conflicts that exist.
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