Evidence Against a Traumatic Brain Injury "July Effect": An Analysis of 3 160 452 Patients From the National Inpatient Sample.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-02-01 Epub Date: 2024-07-11 DOI:10.1227/neu.0000000000003099

Avi A Gajjar, Michael M Covell, Rohit Prem Kumar, Oliver Y Tang, Sruthi Ranganathan, Logan Muzyka, William Mualem, Inaya Rehman, Shrey V Patel, Raj Swaroop Lavadi, Rida Mitha, Bryan A Lieber, D Kojo Hamilton, Nitin Agarwal

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引用次数: 0

Abstract

Background and objectives: The "July Effect" hypothesizes increased morbidity and mortality after the addition of inexperienced physicians at the beginning of an academic year. However, the impact of newer members on neurosurgical teams managing patients with traumatic brain injury (TBI) has yet to be examined. This study conducted a nationwide analysis to evaluate the existence of the "July Effect" in the setting of patients with TBI.

Methods: The Healthcare Cost and Utilization Project Central Distributor's National Inpatient Sample data set was queried for patients with TBI using International Classification of Diseases (ICD)-9 and ICD-10 codes. Discharges were included for diagnoses of traumatic epidural, subdural, or subarachnoid hemorrhages. Only patients treated at teaching hospitals were included to ensure resident involvement in care. Patients were grouped into July admission and non-July admission cohorts. A subgroup of patients with neurotrauma undergoing any form of cranial surgery was created. Perioperative variables were recorded. Rates of different complications were assayed. Groups were compared using χ 2 tests (qualitative variables) and t -tests or Mann-Whitney U -tests (quantitative variables). Logistic regression was used for binary variables. Gamma log-linked regression was used for continuous variables.

Results: The National Inpatient Sample database yielded a weighted average of 3 160 452 patients, of which 312 863 (9.9%) underwent surgical management. Patients admitted to the hospital in July had a 5% decreased likelihood of death ( P = .027), and a 5.83% decreased likelihood of developing a complication ( P < .001) compared with other months of the year. July admittance to a hospital showed no significant impact on mean length of stay ( P = .392) or routine discharge ( P = .147). Among patients with TBI who received surgical intervention, July admittance did not significantly affect the likelihood of death ( P = .053), developing a complication ( P = .477), routine discharge ( P = .986), or mean length of stay ( P = .385).

Conclusion: The findings suggested that there is no "July Effect" on patients with TBI treated at teaching hospitals in the United States.

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反驳创伤性脑损伤 "七月效应 "的证据：对来自全国住院病人样本的 3 160 452 名病人的分析。

背景和目的：根据 "七月效应 "的假设，在一个学年开始时加入缺乏经验的医生会增加发病率和死亡率。然而，新成员对管理创伤性脑损伤（TBI）患者的神经外科团队的影响还有待研究。本研究在全国范围内进行了分析，以评估 "七月效应 "对创伤性脑损伤患者的影响：方法：使用国际疾病分类 (ICD)-9 和 ICD-10 代码查询了医疗成本与利用项目中央分配器的全国住院病人样本数据集，以了解创伤性脑损伤患者的情况。诊断为外伤性硬膜外出血、硬膜下出血或蛛网膜下腔出血的出院病例也包括在内。仅纳入在教学医院接受治疗的患者，以确保住院医师参与护理。患者分为七月入院和非七月入院两组。此外，还将接受任何形式颅脑手术的神经创伤患者分为一组。记录围手术期变量。对不同并发症的发生率进行了评估。使用χ2检验（定性变量）和t检验或曼-惠尼U检验（定量变量）对各组进行比较。二元变量采用 Logistic 回归。连续变量采用伽马对数回归法：全国住院病人抽样数据库得出的加权平均数为 3 160 452 例病人，其中 312 863 例（9.9%）接受了手术治疗。与一年中的其他月份相比，7月份入院的患者死亡的可能性降低了5%（P = .027），发生并发症的可能性降低了5.83%（P < .001）。七月份入院对平均住院时间（P = .392）或常规出院（P = .147）没有明显影响。在接受手术治疗的创伤性脑损伤患者中，7月份入院对死亡（P = .053）、并发症（P = .477）、常规出院（P = .986）或平均住院时间（P = .385）的可能性没有明显影响：研究结果表明，在美国教学医院接受治疗的创伤性脑损伤患者不存在 "七月效应"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.