{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T09:32:11Z","timestamp":1763458331334,"version":"3.45.0"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,5]],"date-time":"2025-01-05T00:00:00Z","timestamp":1736035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["World j. otorhinolaryngol.-head neck surg."],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The \u201cJuly effect,\u201d a theory that the beginning of the academic year has worse operative outcomes and complication rates, remains controversial. We evaluated the \u201cJuly effect\u201d as a risk factor for negative operative outcomes in head and neck microvascular reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multi\u2010institutional 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009143), and the most common postoperative complications were wound infection (12.8%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009370) and dehiscence (7.6%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009221). There were no significant differences between quarters in overall complication rate, flap failures, partial flap necrosis, wound infection, fistula, or hematoma (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). There were also no significant differences in LOS or rates of 30\u2010day readmission or reoperation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Q1 had significantly more dehiscences (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04) and longer operative times (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) than Q4.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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 \u201cJuly effect\u201d 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjo2.233","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T02:50:11Z","timestamp":1736131811000},"page":"433-439","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the \u201cJuly effect\u201d in head and neck microvascular reconstruction: A retrospective review"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1076-1941","authenticated-orcid":false,"given":"Emma","family":"De Ravin","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Thomas Jefferson University Philadelphia Pennsylvania USA"},{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin C.","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan M.","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Thomas Jefferson University Philadelphia Pennsylvania USA"},{"name":"Department of Otolaryngology\/Head and Neck Surgery University of North Carolina Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marah","family":"Sakkal","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"Slijepcevic","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Oregon Health Sciences University Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Petrisor","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Oregon Health Sciences University Portland Oregon USA"},{"name":"Oral and Maxillofacial Surgery Department Oregon Health Sciences University Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farshid","family":"Taghizadeh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Oregon Health Sciences University Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason G.","family":"Newman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head &amp; Neck Surgery Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Curry","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark K.","family":"Wax","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Oregon Health Sciences University Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven B.","family":"Cannady","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-5-201109060-00354"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2021.04.020"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000000887"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2021608"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.05.033"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2020.06.057"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20210618-08"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001999"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002294"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27988"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23884"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22164"},{"key":"e_1_2_11_14_1","unstructured":"BenitoDA MamidiI PasickLJ et al. Evaluating resident involvement and the \u201cJuly effect\u201d in parotidectomy. (2021\u201004\u201029)[2024\u201009\u201009].https:\/\/www.cambridge.org\/core\/journals\/journal-of-laryngology-and-otology\/article\/evaluating-resident-involvement-and-the-july-effect-in-parotidectomy\/06044F12802C87E3B478C48AC6AE58D6."},{"key":"e_1_2_11_15_1","unstructured":"KliffS. The July effect is real: new doctors really do make hospitals more dangerous. Vox. (2014\u201007\u201013)[2022\u201008\u201023].https:\/\/www.vox.com\/2014\/7\/13\/5893653\/the-july-effect-is-real-new-doctors-really-do-make-hospitals-more."},{"key":"e_1_2_11_16_1","unstructured":"MillerJ. The July effect. (2013\u201011\u20106)[2022\u201008\u201023].https:\/\/hms.harvard.edu\/news\/july-effect."},{"key":"e_1_2_11_17_1","unstructured":"WhitmanE. How hospitals see the so\u2010called \u201cJuly effect\u201d. 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