Debunking the July Effect in Transcatheter Interventions in Structural Heart Disease: Truth or Myth?

Sameer A. Hirji, MD, MPH; Supreet Singh, MD; Alexis K. Okoh, MD; Alexandra Malarczyk, BS; Edward D. Percy, MD; Morgan T. Harloff, MD; Ahmed A. Kolkailah, MD, MSc; Cheryl K. Zogg, MSPH, MHS, PhD; Emefah Loccoh, MD; Farhang Yazdchi, MD; Mark J. Russo, MD; Patrick O'Gara, MD; Pinak Shah, MD; Tsuyoshi Kaneko, MD

Structural Heart (Apr 2022)

Debunking the July Effect in Transcatheter Interventions in Structural Heart Disease: Truth or Myth?

Sameer A. Hirji, MD, MPH,
Supreet Singh, MD,
Alexis K. Okoh, MD,
Alexandra Malarczyk, BS,
Edward D. Percy, MD,
Morgan T. Harloff, MD,
Ahmed A. Kolkailah, MD, MSc,
Cheryl K. Zogg, MSPH, MHS, PhD,
Emefah Loccoh, MD,
Farhang Yazdchi, MD,
Mark J. Russo, MD,
Patrick O'Gara, MD,
Pinak Shah, MD,
Tsuyoshi Kaneko, MD

Affiliations

Sameer A. Hirji, MD, MPH: Division of Cardiac Surgery, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Supreet Singh, MD: Cardiovascular Research Institute, RWJ Barnabas Health, Newark, New Jersey, USA
Alexis K. Okoh, MD: Cardiovascular Research Institute, RWJ Barnabas Health, Newark, New Jersey, USA
Alexandra Malarczyk, BS: Division of Cardiac Surgery, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Edward D. Percy, MD: Division of Cardiac Surgery, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Morgan T. Harloff, MD: Division of Cardiac Surgery, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Ahmed A. Kolkailah, MD, MSc: Department of Medicine, Cook County Health, Chicago, Illinois, USA
Cheryl K. Zogg, MSPH, MHS, PhD: Yale School of Medicine, New Haven, Connecticut, USA
Emefah Loccoh, MD: Division of Cardiac Surgery, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Farhang Yazdchi, MD: Division of Cardiac Surgery, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Mark J. Russo, MD: Cardiovascular Research Institute, RWJ Barnabas Health, Newark, New Jersey, USA
Patrick O'Gara, MD: Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Pinak Shah, MD: Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Tsuyoshi Kaneko, MD: Division of Cardiac Surgery, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; Address correspondence to: Tsuyoshi Kaneko, MD, Division of Cardiac Surgery, Brigham and Women’s Hospital, 15 Francis Street, Boston, MA, 02115

Journal volume & issue: Vol. 6, no. 1
p. 100001

Abstract

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Background: The “July effect”, the perception of worse outcomes in the first month of training, has been previously demonstrated in critical care medicine and general surgery. However, the July effect in the context of structural heart interventions (i.e., transcatheter aortic valve replacement [TAVR] and MitraClip) remains unknown. Methods: All adult patients undergoing TAVR or MitraClip in the 2012-2016 National Inpatient Sample were included. Outcomes were compared by procedure month and academic year quartiles (i.e., between the first academic year quartile [Q1] vs. the fourth quartile [Q4]). Outcomes between teaching and nonteaching hospitals were compared using risk-adjusted logistic difference-in-difference regression. Results: During the study period, 94,170 TAVR (Q1: 25,250; Q4: 23,170) and 8750 MitraClip (Q1: 2220; Q4: 2150) procedures were performed. In-hospital mortality did not vary as per academic year quartiles for either procedure, even after risk adjustment. These findings persisted in sensitivity analysis by procedure month and newer device era (2015-2016; all p > 0.05). In the subgroup analysis, the unadjusted and adjusted Q1 vs. Q4 in-hospital mortality between teaching and nonteaching hospitals were similar for either procedure. In-hospital mortality also did not vary by procedure month when stratified by hospital teaching status for both procedures. However, postprocedural complication rates appeared to be improving among the TAVR teaching hospitals for stroke, major bleeding, and vascular complications (all p < 0.05). Conclusions: In this large, nationwide study, the July effect was not evident for structural heart interventions. With increasing interest and growth in transcatheter procedures, early resident and fellow teaching can be achieved with appropriate supervision.

Published in Structural Heart

ISSN: 2474-8706 (Print); 2474-8714 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/structural-heart

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