Debunking the July Effect in Lung Transplantation Recipients

Objective The “July Effect” is a theory that the influx of trainees from July through September negatively impacts patient outcomes. We aimed to study this theoretical phenomenon in lung transplantation recipients given the highly technical nature of thoracic procedures. Methods Adult lung transplant hospitalizations were identified within the National Inpatient Sample (2005-2020). Recipients were categorized as academic Q1 (July-September) or Q2-Q4 (October-June). In-hospital mortality, operator-driven complications (pneumothorax, dehiscence, and vocal cord/diaphragm paralysis, all three treated as a composite outcome), length of stay, and inflation-adjusted hospitalization charges were compared between both groups. Multivariable logistic regression was performed to assess the association between academic quarter vs. in-hospital mortality and operator-driven complications. The models were adjusted for recipient demographics and transplant characteristics. Subgroup analysis was performed between academic and non-academic hospitals. Results Of 30,788 lung transplants, 7,838 occurred in Q1 and 22,950 in Q2-Q4. Recipient demographic and clinical characteristics were similar between groups. Dehiscence (n=922, 4% vs. n=236, 3%), post-transplant cardiac arrest (n=532, 2% vs. n=113, 1%), and pulmonary embolism (n=712, 3% vs. n=164, 2%) were more common in Q2-Q4 vs. Q1 recipients (all p<0.05). Other operator-driven complications, in-hospital mortality, and resource utilization were similar between groups (p>0.05). These inferences remained unchanged in adjusted analyses and on subgroup analyses of academic vs. non-academic hospitals. Conclusions The “July Effect” is not evident in U.S. lung transplantation recipient outcomes during the transplant hospitalization. This suggests that current institutional monitoring systems for trainees across multiple specialties including surgery, anesthesia, critical care, nursing, and others are robust.