Evaluating the July Phenomenon in Plastic Surgery: a NSQIP Analysis

Background: The perception that complications are more frequent during the early months of the medical academic year, known as the "July Phenomenon," has been studied in several specialties with conflicting results. This phenomenon has yet to be studied in plastic surgery; therefore, the purpose of this study was to evaluate the presence of the July Phenomenon within plastic surgery. Methods: The ACS-NSQIP database was accessed and cases from 2005-2014 where "Plastic Surgery" was listed as the surgical specialty were identified. Cases with trainee involvement were included for analysis and stratified into two groups based on calendar-year quarter of admission. The Q3 group included 2,451 cases performed during July-September of each calendar year and the RQ group included 7,131 cases performed in the remaining quarters of each calendar year within the study period. Complication rates for 24 complications of interest for Q3 and RQ cases with trainee involvement were calculated, Chi-square analysis was used to compare complication rates between Q3 and RQ groups. Multivariate regression analysis was performed to control for potential confounders. Results: Comparison of complication rates within operations with trainee involvement showed a statistically significant increase in Q3 vs RQ for superficial wound infection (0.032 vs. 0.023, p=0.046) and wound dehiscence (0.010 vs. 0.006, p =0.034). No significant difference was found for the remaining 22 complications evaluated. Conclusion: This study of a nationwide surgical database found that for the vast majority of complications coded in the NSQIP database, rates do not increase in the beginning of the academic year * These authors contributed equally to this work. Financial Disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Accepted for presentation at Plastic Surgery, The Meeting: 2017. Corresponding author: Eduardo D. Rodriguez, MD, DDS, Chair, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 305 East 33rd Street, New York, New York, 10016. Phone: (212) 263-8745, Fax: (212) 263-8492, Email: eduardo.rodriguez@nyumc.org ©2018American Society of Plastic Surgeons