Study finds outcomes from spinal surgery are no worse when trainee doctors start work

BMJ 2013; 346 doi: (Published 29 January 2013) Cite this as: BMJ 2013;346:f618
  1. Susan Mayor
  1. 1London

Rates of major adverse outcomes are no higher in patients having spinal surgery during July, when new trainee doctors start working in US teaching hospitals, says a US study,1 which the authors say debunks the myth that this is the worst time to be a patient.

Researchers analysed data for nearly one million patients having spinal surgery (such as discectomy or laminectomy) between 2001 and 2008, collected in the Nationwide Inpatient Sample, a large public database of US hospital inpatients. They compared outcomes in patients having surgery in July with those in patients having the same operations in other months.

Results showed that patients admitted to teaching hospitals in July for spinal surgery had similar rates of major adverse events as those having surgery at other times of the year. There was no difference in the risk of inhospital mortality (odds ratio 0.94, 95% confidence interval 0.77 to 1.02, P=0.09), reaction to implanted device or instrumentation (0.88, 0.94 to 1.33, P=0.20), or postoperative wound dehiscence (1.12, 0.94 to 1.33, P=0.20).

The risks were slightly higher for postoperative infection (1.11, 1.05 to 1.17, P=0.0341) and being discharged to a long term care facility (1.03, 1.00 to 1.07, P=0.0467) among patients undergoing spinal surgery in July compared with other months. The study’s authors considered that because these complications are wound related and likely to be managed by junior doctors the increased rates might suggest the presence of a learning curve. “However the magnitude of the difference was quite small,” they pointed out.

“We hope that our findings will reassure patients that they are not at higher risk of medical complications if they undergo spinal surgery during July as compared to other times of the year,” said Jennifer McDonald, a radiologist at the Mayo Clinic, Rochester, Minnesota, and one of the study’s authors. She added, “While we only looked at spinal surgeries, we think it’s likely we’d find similar outcomes among other surgeries and procedures.”


Cite this as: BMJ 2013;346:f618