“July Effect” and Appendicitis

Background

Patients at teaching hospitals often worry about the involvement of inexperienced surgical residents in their care. The most apparent time that physician inexperience would affect surgical outcomes would be in July, which is the start of residency training. The purpose of our study was to determine whether the morbidity related to the management of appendicitis was higher in the beginning of the academic year.

Methods

A retrospective review of all appendicitis cases between 1998 and 2007 at 2 public teaching hospitals was conducted. An analysis was performed comparing all appendicitis cases in July/August versus all other months of the academic year. The outcome variables were wound infection rate, postoperative abscess drainage rate, and length of hospitalization (LOH).

Results

A total of 4325 patients were included in the study. Patient demographics and appendiceal perforation rate were similar between July/August and the rest of the year. Wound infection rate, postoperative abscess drainage rate, and LOH were also similar between these 2 time periods.

Conclusions

Appendicitis outcomes were similar in the beginning of the academic year in comparison with the remaining months. These findings suggest that patients with acute appendicitis can safely undergo emergency surgery early in the training year.

Key Words: surgical education, surgery residency, resident education, outcomes, appendicitis

Competency: Patient Care, Medical Knowledge, Interpersonal and Communication Skills