Operative Intervention of Supracondylar Humerus Fractures More Complicated in July

Analysis of the July Effect

Deren T. Bagsby, Randall Loder, Karen Myung

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: The "July Effect" involves the influx of new interns and residents early in the academic year (July and August), which may have greater potential for poorer patient outcomes. Current orthopaedic literature does not demonstrate the validity of this concept in arthroplasty, spine, hand, and arthroscopy. No study has investigated the possibility of this effect on common pediatric orthopaedic procedures, such as closed reduction and percutaneous pin fixation of supracondylar humerus fractures. Methods: A retrospective review of all type II or III supracondylar humerus fractures that underwent primary closed reduction and percutaneous pin fixation (CPT code 24538) at a single pediatric level 1 trauma center from July 2009 to June 2013. Patients were grouped according to time in the academic year: early (July and August) and late (May and June). Demographic data included length of follow-up, age at surgery, sex, side of injury, and Wilkin's modified Gartland classification. Outcomes included length of operation, number of pins used, length of stay, complications, and the need for repeat surgery. Results: There were 245 patients, 101 in the early and 144 in the late group. There was no increase in surgical time [33.32±24.74 (early) vs. 28.63±10.06 (late) min, P=0.07) or complication rates [7.0% (early) vs. 2.1% (late), P=0.06) between the early and the late groups. Cases performed with junior residents demonstrated longer operative (31.72±17.07 vs. 28.96±18.71 min, P=0.02) and fluoroscopy (48.63±30.96 vs. 34.12±27.38 s, P=0.01) times. Conclusions: The academic orthopaedic surgeon must ensure the education of residents, while providing the highest level of safety to patients. Our study shows that education of young residents early in the academic year results in no increase in operative times, radiation exposure, or complications. Level of Evidence: Level III.

Original languageEnglish (US)
Pages (from-to)254-257
Number of pages4
JournalJournal of Pediatric Orthopaedics
Volume37
Issue number4
DOIs
StatePublished - 2017

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Humerus
Operative Time
Current Procedural Terminology
Pediatrics
Orthopedic Procedures
Education
Trauma Centers
Fluoroscopy
Arthroscopy
Patient Safety
Reoperation
Arthroplasty
Orthopedics
Length of Stay
Spine
Hand
Demography
Wounds and Injuries

Keywords

  • July Effect
  • new interns and residents
  • perioperative outcomes
  • supracondylar humerus fractures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Operative Intervention of Supracondylar Humerus Fractures More Complicated in July : Analysis of the July Effect. / Bagsby, Deren T.; Loder, Randall; Myung, Karen.

In: Journal of Pediatric Orthopaedics, Vol. 37, No. 4, 2017, p. 254-257.

Research output: Contribution to journalArticle

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