PS4-09: DO GENERAL SURGERY RESIDENTS BECOME FASTER IN THE OR THROUGHOUT THE ACADEMIC YEAR?
Steven Gurien, MD, Ronald Dela Cruz, MD, Matthew Giangola, MD, Jeffrey Nicastro, MD, Vihas Patel, MD, Isadora Botwinick, MD; Northwell Health

Introduction: Multiple studies have investigated the so-called “July Effect” – the concept that medical care at the beginning of the academic residency year is inferior to care later in the year. We chose to investigate this phenomenon in general surgery residents, specifically focusing on appendectomies and cholecystectomies, two of the most common emergency general surgery procedures. We hypothesized that operative time would decrease over the course of the academic year, with a decrease in post-operative complications.

Methods: We analyzed 1466 patients from our ACS-NSQIP database from 2012-2018 who underwent an appendectomy or cholecystectomy at our institution. We collected clinical data about patients which could potentially impact operative time, including age, BMI and coagulation profile. Operative time and outcomes were analyzed by comparing the first six months of the academic year (July–December) to the second six months (January–June). We also examined quality measures such as frequency of urinary tract infections (UTI), wound complications, and time to discharge. Mann Whitney-U test was used to compare continuous data and chi squared test to compare categorical data.

Results: Patient age, BMI and coagulation profile were similar over the course of a year. Median operative time for all cases in the second half of the academic year was significantly shorter compared to the first half of the year (59 vs 64 minutes;p=0.01). In a subgroup analysis, this finding held true for all appendectomies (48 vs 53 minutes;p=0.003), and all laparoscopic cases (58 vs 61 minutes;p=0.02). However, there was no difference in operative time for the open cases or the subgroup of cholecystectomies. Additionally, there was a decrease in wound complications in the second half of the academic year for both surgeries combined when compared to the first half of the year (0.6% vs 1.8%;p=0.048). There was no difference in UTI frequency or time to discharge.

Conclusion: Operative time as well as wound complications decreased over the academic year, although the absolute difference is probably not clinically significant. Further investigation is needed, but patients and families should be confident that they are getting safe and quality general surgery care, even in July.