P0725 - Exploring the July Phenomenon on Hospital Outcomes and Endoscopic Treatment in Acute Non-Variceal Upper Gastrointestinal Bleeding: A 5-Year Retrospective Study

Adedeji Adenusi, MD, MPH¹, Chima Amadi, MD, MBA², Joseph Atarere, MD, MPH³, Eugene Annor, MD, MPH⁴, Toni M. Jackson, DO⁵, Oluwatayo J. Awolumate, MD⁶, Julia J.. Liu, MD^7
1One Brooklyn Health-Interfaith Medical Center, Brooklyn, NY; ²Morehouse School of Medicine, Atlanta, GA; ³MedStar Union Memorial Hospital, Baltimore, MD; ⁴University of Illinois College of Medicine, Morton, IL; ⁵Morehouse School of Medicine, Far Rockaway, NY; ⁶Howard University Hospital, Washington, DC; ⁷Morehouse School of Medicine, Decatur, GA

Introduction: The July phenomenon, sometimes called the “July effect,” refers to adverse patient outcomes related to the changeover of medical residents in teaching hospitals at a particular time of the year. There have been mixed studies on the significance of the July effect on patient care, particularly acute upper gastrointestinal bleeding (UGIB), a medical emergency with an associated 2-10% death rate. This study aims to explore the July effect on hospital outcomes and endoscopic treatment among patients diagnosed with UGIB.

Methods: We reviewed the National Inpatient Sample (NIS) data from Jan 1, 2016, to Dec 31, 2020, to examine the effect of time of year. We sampled patients admitted from May through August and stratified patients into two groups: May and June (No July Effect) and July and August (July Effect) with primary diagnosis of UGIB. We assessed mortality rate, complications, and timing of endoscopic treatment, adjusted for socio-demographic, hospital characteristics, and associated comorbidities. The chi-square test was used to compare categorical variables, descriptive analysis, and bivariate and multivariate logistic regressions to identify and compare the July effect on mortality risk among the two groups.

Results: A total of 8,360,857 (weighted frequency) patients were admitted from May-August with < 1% diagnosed with UGIB and 3% experiencing death. On the comparison of the mortality risk for UGIB between the groups, the study revealed there was no difference between the July effect group (aOR = 0.513, 95% CI: 0.410-0.642, p < .0001) and non-July effect group (aOR = 0.503, 95% CI: 0.397-0.636, p < .0001). The timing of endoscopy (< =24hrs from admission) showed no difference between groups (27.969% vs 25.787%, p = 0.2424). Length of stay showed no significant difference during the July effect group (aOR = 0.992, 95% CI: 0.925-1.065, p = 0.8332) but was higher during the non-July effect period (aOR = 1.095, 95% CI: 1.021-1.174, p = 0.0109). Hospital charges were noted to be higher in the July effect group (aOR = 1.086 (1.031-1.145), p < .0021) than in the non-July effect group (aOR = 1.050 (0.996-1.106), p < .0697).

Discussion: Our study findings showed no difference in mortality and timing to endoscopy. However, Longer length of stay was noted in the non-July effect group, while increased hospital charges were seen in the July effect group. Since the NIS dataset accounts for less than 20% of all hospital discharges, the absence of the “July effect” in our study is not definitive.


Disclosures:


Adedeji Adenusi, MD, MPH¹, Chima Amadi, MD, MBA², Joseph Atarere, MD, MPH³, Eugene Annor, MD, MPH⁴, Toni M. Jackson, DO⁵, Oluwatayo J. Awolumate, MD⁶, Julia J.. Liu, MD⁷. P0725 - Exploring the July Phenomenon on Hospital Outcomes and Endoscopic Treatment in Acute Non-Variceal Upper Gastrointestinal Bleeding: A 5-Year Retrospective Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.