July effect in clinical outcomes of esophagogastroduodenoscopy performed at teaching hospitals in the United States

Abstract

Background

Esophagogastroduodenoscopy (EGD) is a common procedure used for both diagnosis and treatment, but carries risks such as bleeding and perforation. The “July effect”—described as increased complication rates during the transition of new trainees—has been studied in other procedures, but has not been thoroughly evaluated for EGD.

Methods

We used the National Inpatient Sample database for 2016 to 2018 to compare outcomes in EGD performed between July to September and April to June.

Results

Approximately 0.91 million patients in the study received EGD between July to September (49.35%) and April to June (50.65%), with no significant differences between the two groups in terms of age, gender, race, income, or insurance status. Of the 911,235 patients, 19,280 died during the study period following EGD, 2.14% (July–September) vs 1.95% (April–June), with an adjusted odds ratio of 1.09 (P < 0.01). The adjusted total hospitalization charge was $2052 higher in July–September ($81,597) vs April to June ($79,023) (P < 0.005). The mean length of stay was 6.8 days (July–September) vs 6.6 days (April–June) (P < 0.001).

Conclusions

The results of this study are reassuring as the July effect on inpatient outcomes for EGDs was not significantly different according to our study. We recommend seeking prompt treatment and improving new trainee training and interspecialty communication for better patient outcomes.

Keywords:

• Clinical outcomes
• esophagogastroduodenoscopy
• July effect
• National Inpatient Sample

Disclosure statement/Funding

No funding or potential conflict of interest was reported by the authors.