Association between surgical complications and early academic period in women undergoing cesarean delivery

Abstract

Objective

To compare rates of operative complications between the earlier and later academic periods.

Study design

This was a retrospective cohort study of women undergoing cesarean delivery at 23 weeks’ gestation or greater during the academic calendar between 2012 and 2017. Our primary outcome was a composite of surgical complications including hemorrhage (4 or more red blood cell transfusion), bladder injury, bowel injury, neonatal injury, cellulitis, wound complications, intensive care unit admission, and readmission. Outcomes were compared between two periods – the earlier academic period (July and August) and the later academic period (April and May). Multivariable logistic regression or linear regression was performed, controlling for predefined covariates.

Results

There were 1251 and 1111 cesarean delivery in the earlier and later academic periods, respectively. The earlier academic period compared to the late academic period was associated with a minute longer incision to delivery time (9 versus 8 min, adjusted p < .01) and a 2.5-min longer surgical duration (49 versus 46.5 min, adjusted p < .01). There was no difference in the primary outcome (10.5 versus 9.6%; adjusted odds ratio 1.11 [0.84–1.46]).

Conclusions

Cesarean deliveries performed in the early months of the academic period was not associated with increased odds of surgical complications.

Keywords:

• Cesarean delivery
• July effect
• residency
• surgical complications
• obstetrics and gynecology

Ethical approval

MedStar Institutional Review Board approved this study (2018–176, approved on 9 November 2018).

Disclosure statement

No potential conflict of interest was reported by the authors. The content of the present work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Additional information

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number [UL1TR001409].