Citation
Oben, Ayamo; McGee, Paula L.; Grobman, William A.; Bailit, Jennifer L.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M., Jr.; Caritis, Steve N.; Prasad, Mona; & Saade, George R., et al. (2022). An Evaluation of Seasonal Maternal/Neonatal Morbidity Related to Trainee Cycles. American Journal of Obstetrics & Gynecology, 4(3), 100583. PMCID: PMC9081218Abstract
BACKGROUND: The existence of the "July Phenomenon" (worse outcomes related to the presence of new physician trainees in teaching hospitals) has been debated in the literature and media. Prior studies of the phenomenon in obstetrics are limited by the quality and detail of data.OBJECTIVE: To evaluate whether the months of June-August, when transitions in trainees occur, are associated with increased maternal and neonatal morbidity.
STUDY DESIGN: Secondary analysis of an observational cohort of 115,502 mother/infant pairs that delivered at 25 hospitals from March 2008 to February 2011. Inclusion criteria were an individual who had a singleton, non-anomalous live fetus at the onset of labor, and delivered at a hospital with trainees. The primary outcomes were composites of maternal and neonatal morbidity. We evaluated the outcomes by academic quarter during which the delivery occurred beginning July 1st as well as duration of the academic year as a continuous variable. To account for clustering in outcomes at a given delivery location, we applied hierarchical logistic regression with adjustment for hospital as a random effect.
RESULTS: Of 115,502 deliveries, 99,929 met inclusion criteria. Race and ethnicity, insurance, body mass index, drug use, and 24/7 maternal-fetal medicine, anesthesia and neonatology availability varied by quarter. In adjusted analysis, the frequencies of the composite maternal and neonatal morbidities did not differ by quarter. No differences in composite morbidities were observed when using day as a continuous variable (maternal morbidity aOR 1.00; 95%CI 0.99 -1.00 and neonatal morbidity aOR 1.00; 95%CI 1.00 - 1.01) and after adjustment for hospital as a random effect. Odds of major surgical complications in quarter 2 was twice that for quarter 1. Neonatal injury and ICU care were less frequent in later quarters.
CONCLUSION: Maternal and neonatal morbidity in teaching hospitals was not associated with the academic quarter during which delivery occurred, and there was no evidence of a "July Phenomenon".
URL
http://dx.doi.org/10.1016/j.ajogmf.2022.100583Reference Type
Journal ArticleYear Published
2022Journal Title
American Journal of Obstetrics & GynecologyAuthor(s)
Oben, AyamoMcGee, Paula L.
Grobman, William A.
Bailit, Jennifer L.
Wapner, Ronald J.
Varner, Michael W.
Thorp, John M., Jr.
Caritis, Steve N.
Prasad, Mona
Saade, George R.
Rouse, Dwight J.
Blackwell, Sean C., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network