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August 1, 1990

It's Not OK to Get Sick in July

Author Affiliations

Kaiser Permanente Oakland, Calif

Kaiser Permanente Oakland, Calif

JAMA. 1990;264(5):573. doi:10.1001/jama.1990.03450050031018

To the Editor.—  I would like to note some findings from a study of mortality following unscheduled surgery in Maryland hospitals that I believe are pertinent to the recent editorial by Dr Perry1 and the related article by Rich et al.2 In the Maryland study, my colleagues and I made case-specific adjustments in risk using procedures performed, diagnoses present on admission, age, sex, and preoperative stay. The Table summarizes the findings for patients admitted in July 1984 (these data are described elsewhere in more detail3).The difference between the observed-to-expected ratio of deaths at teaching hospitals and other hospitals had a χ2 value of 5.3 (P<.025, 1 df).4 Teaching hospitals were not adverse for patients admitted in all other months together, excluding July.There are several limitations in the study by Rich et al that reduced their prospect of detecting any possible association of house officer experience with risk-adjusted mortality in July. They did not specifically test for July house officer status as a predictor of mortality. Two continuous variables in their logistic regression model were both related