DON’T GET ILL IN AUGUST …

Englesbe MJ, Pelletier SJ, Magee JC, et al. Seasonal variation in surgical outcomes as measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg 2007;246:456–65.

Fresh concern was raised in the British press recently with regard to the safety of returning to a “mass” change-over of junior staff in UK hospitals. Change-over of junior staff had been staggered by grade for many years because of the perception that mortality and morbidity rates were higher in August and February. Similar concerns exist in the US and the authors of this article sought to examine the validity of those concerns.

This observational, multi-institutional study was conducted by analysis of the National Surgical Quality Improvement Program-Patient Safety in Surgery Study database. The 30-day morbidity and mortality rates between two periods of care were compared (early group, 1 July to 30 August and late group, 15 April to 15 June). A prediction model was then constructed via stepwise logistic regression. The results demonstrated an 18% higher risk of postoperative morbidity in the early (n = 9941) vs the late group (n = 10 313) (OR 1.18, 95% CI 1.07 to 1.29, p = 0.0005, c-index 0.794) and a 41% higher risk for mortality in the early group compared with the late group (OR …