Evaluating the Impact of Resident Participation and the July Effect on Outcomes in Autologous Breast Reconstruction

Objective Although resident involvement in surgical procedures is critical for training, it may be associated with increased morbidity, particularly early in the academic year—a concept dubbed the "July effect." Assessments of such phenomena within the field of plastic surgery have been both limited and inconclusive. We sought to investigate the impact of resident participation and academic quarter on outcomes for autologous breast reconstruction. Methods All autologous breast reconstruction cases after mastectomy were gathered from the 2005–2012 American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression models were constructed to investigate the association between resident involvement and the first academic quarter (Q1 = July-September) with 30-day morbidity (odds ratios [ORs] with 95% confidence intervals). Medical and surgical complications, median operation time, and length of stay (LOS) were also compared. Results Overall, 2527 cases were identified. Cases with residents (n = 1467) were not associated with increased 30-day morbidity (OR, 1.20; 0.95–1.52) when compared with those without (n = 1060), although complications including transfusion (OR, 2.08; 1.39–3.13) and return to the operating room (OR, 1.46; 1.11–1.93) were more frequently observed in resident cases. Operation time and LOS were greater in cases with resident involvement. In cases with residents, there was decreased morbidity in Q1 (n = 343) when compared with later quarters (n = 1124; OR, 0.67; 0.48–0.92). Specifically, transfusion (OR, 0.52; 0.29–0.95), return to operating room (OR, 0.64; 0.41–0.98), and surgical site infection (OR, 0.37; 0.18–0.75) occurred less often during Q1. No differences in median operation time or LOS were observed within this subgroup. Conclusions Our study reveals that resident involvement in autologous breast reconstruction is not associated with increased morbidity and offers no evidence for a July effect. Notably, our results suggest that resident cases performed earlier in the academic year, when surgical attendings may offer more surveillance and oversight, is associated with decreased morbidity.