J Cerebrovasc Endovasc Neurosurg.  2013 Jun;15(2):67-75. 10.7461/jcen.2013.15.2.67.

Impact of Admission Month on Outcomes in Spontaneous Subarachnoid Hemorrhage: Evidence Against the March Effect

• Kim HS
• Park CW
• Yoo CJ
• Kim EY
• Kim YB
• Kim WK

• KMID: 1980432
• DOI: http://doi.org/10.7461/jcen.2013.15.2.67

Abstract

OBJECTIVE
We attempted to identify the presence of a so called 'March effect (or phenomenon)' (which had long been known as a 'July effect' in western countries), a transient increase in adverse outcomes during an unskilled period for new interns and residents in a teaching hospital, among a cohort of patients with spontaneous subarachnoid hemorrhage (sSAH).
METHODS
A total of 455 consecutive patients with sSAH from our department database from 2008 to 2010 were enrolled retrospectively and the admission month, patient demographics and clinical characteristics, treatment modalities and discharge outcomes were analyzed. Multivariate regression analysis was used to determine whether unfavorable discharge and in-hospital mortality showed a significant increase during the unskilled months for new interns and residents (from March to May) in a pattern suggestive of a "March effect".
RESULTS
Among 455 patients with sSAH, 113 patients were treated during the unskilled period (from March to May) and the remaining 342 patients were treated during the skilled period (from June until February of the next year). No statistically significant difference in demographics and clinical characteristics was observed between patients treated during these periods. In addition, the mortality and unfavorable discharge rates of the un-skilled period were 16.8% and 29.7% and those of the skilled period were 15.5% and 27.2%, respectively. However, no statistically significant difference was observed between them.
CONCLUSIONS
Findings of our study suggest that there was no 'March effect' on the mortality rate and unfavorable discharge rate among patients with sSAH in our hospital during the study period.

Keyword

Spontaneous subarachnoid hemorrhage; March effect; Mortality rate; July effect; Teaching hospital

MeSH Terms

Cohort Studies
Demography
Hospital Mortality
Hospitals, Teaching
Humans
Retrospective Studies
Subarachnoid Hemorrhage

Figure

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  Fig. 1 Mortality rate and unfavorable discharge

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  Fig. 2 Statistical analysis of mortality rate according to admission quarter

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  Fig. 3 Statistical analysis of unfavorable discharge according to admission quarter

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