The “July Effect” on Shoulder Arthroplasty: Are Complication Rates Higher at the Beginning of the Academic Year?

Document Type : RESEARCH PAPER


1 Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA Harvard Combined Orthopaedic Residency Program, Boston MA, USA

2 Department of Orthopaedic Surgery, Tufts Medical Center, Boston MA, USA

3 Department of Surgery and Perioperative Care, Dell Medical School, Austin MA, USA

4 Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA


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.


Main Subjects

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Volume 6, Issue 4
July 2018
Pages 277-281
  • Receive Date: 25 June 2017
  • Revise Date: 24 October 2017
  • Accept Date: 11 November 2017
  • First Publish Date: 01 July 2018