OBJECTIVES/HYPOTHESIS: A "July effect" of increased complications when new 
trainees begin residency has been reported widely by the media. We sought to 
determine the effect of admission month on in-hospital mortality, complications, 
length of hospitalization, and costs for patients undergoing head and neck 
cancer (HNCA) surgery.
STUDY DESIGN: Retrospective cross-sectional study.
METHODS: Discharge data from the Nationwide Inpatient Sample for 48,263 patients 
who underwent an ablative procedure for a malignant oral cavity, laryngeal, 
hypopharyngeal, or oropharyngeal neoplasm in 2005 to 2008 were analyzed using 
cross-tabulations and multivariate regression modeling.
RESULTS: There were 3,812 cases admitted in July (8%). July admission was 
significantly associated with Medicaid (RRR 1.40, P = 0.011) or self-pay payor 
status (RRR 1.40, P = 0.022), medium hospital bed size (RRR 1.63, P = 0.033) and 
large hospital bed size (RRR 1.73, P = 0.013). There was no association between 
July admission and other patient or hospital demographic characteristics. Major 
procedures and comorbidity were significantly associated with in-hospital death, 
surgical and medical complications, length of hospitalization, and costs, but no 
association was found for July admission, July through September discharge, or 
teaching hospital status and short-term morbidity or mortality. Teaching 
hospitals and large hospital bed size were predictors of increased length of 
hospitalization and costs; and private, for profit hospitals were additionally 
associated with increased costs. No interaction between July admission and 
teaching hospitals was found for any of the outcome variables studied.
CONCLUSIONS: These data do not support evidence of a "July effect" or an 
increase in morbidity or mortality at teaching hospitals providing HNCA surgical 
care.