Introduction: The “July Effect” is a theoretical decline in quality of care associated with the annual introduction of new trainees at the start of an academic year. In acute ischemic stroke (AIS), a time-critical emergency, any variation in care delivery could significantly impact treatment decisions and outcomes. Therefore, we analyzed treatment patterns and outcomes in July vs non-July AIS to determine if a decline in stroke care from new trainees is a genuine effect or an unfounded concern. Methods: Using the 2022 National Inpatient Sample, we performed a large, retrospective study of hospital discharges for AIS in the United States. Adult patients (≥18 years) hospitalized with AIS were identified using appropriate ICD-10 codes. Non-teaching hospital discharges were excluded. Patients were split into two groups depending on admission month (July vs non-July) and stroke treatments, hospital outcomes and hospital complications were compared. Results: In 2022, there were 548, 720 AIS discharges from academic hospitals with 46, 230 (8. 4%) in July and 502, 490 (91. 6%) in non-July months. These patients had similar median age (70 vs 70), gender (female 48. 3 vs 48. 3%), and severity of illness (extreme loss of function 26. 2 vs 28. 1%). There were similar rates of acute stroke treatments including intravenous thrombolysis (10. 8 vs 10. 9%) and endovascular thrombectomy (8. 2 vs 8. 0%) between the two groups. July patients had similar median hospital duration (5 vs 5 days) and median total hospital charges (69, 397 vs 69, 963). Interestingly, although the absolute differences are small, July patients had lower hospital mortality (6. 9 vs 8. 3%, p<0. 01) and were more likely to be discharged home (34. 1 vs 32. 4%, p <0. 01). Most complications such as hemorrhagic transformation (6. 7 vs 6. 8%) and acute kidney injury (22. 3 vs 23. 0%) were similar, but July patients had lower rates of sepsis (8. 3 vs 9. 5%, p<0. 01) and pneumonia (7. 5 vs 8. 8%, p <0. 01). Conclusions: July stroke patients had similar rates of acute stroke therapies as well as similar outcomes and complications. Therefore a “July Effect” in stroke care appears to be a myth. These findings reflect the resilience of modern stroke systems at academic centers. *Automated assistive writing technologies and tools were used for editing and formatting the abstract. The study design, analysis and conclusion were developed entirely by the authors.
Patel et al. (Thu,) studied this question.