Impact of the “July effect” in head and neck microvascular reconstruction: A retrospective review

Objective: The “July effect,” a theory that the beginning of the academic year has worse operative outcomes and complication rates, remains controversial. We evaluated the “July effect” as a risk factor for negative operative outcomes in head and neck microvascular reconstruction. Methods: Multi-institutional retrospective review at three academic tertiary care centers from January 2010 to August 2021. Free flaps were stratified by the academic quarter. Patient factors, operative variables, length of stay (LOS), flap failures, and postoperative complications and adverse events were compared between academic quarters 1 and 4. Results: We identified 2897 free flaps: 749 quarter 1 (Q1), 693 quarter 2 (Q2), 770 quarter 3 (Q3), and 685 quarter 4 (Q4). Overall flap failure rate was 4.9% (n = 143), and the most common postoperative complications were wound infection (12.8%, n = 370) and dehiscence (7.6%, n = 221). There were no significant differences between quarters in overall complication rate, flap failures, partial flap necrosis, wound infection, fistula, or hematoma (p > 0.05). There were also no significant differences in LOS or rates of 30-day readmission or reoperation (p > 0.05). Q1 had significantly more dehiscences (p = 0.04) and longer operative times (p = 0.001) than Q4. Conclusion: Although Q1 surgeries had significantly longer operative times and higher dehiscence rates, we found no other differences in postoperative complications, flap failures, or adverse events by the academic quarter. While a “July effect” may exist due to the integration of new trainees into the surgical workflow, this effect does not translate into meaningful differences in overall free flap or patient outcomes.