Yale School of Medicine, New Haven, CT 2

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Supplement for:

Reassessing the July Effect: 30 Years of Evidence Show No Difference in Outcomes

Cheryl K. Zogg, PhD, MSPH, MHS,^1-3 David Metcalfe, PhD, MRCP, MRCS, MRCEM,⁴ Claire M. Sokas, MD,² Michael K. Dalton, MD, MPH,² Sameer A. Hirji, MD, MPH,² Kimberly A. Davis, MD, MBA, FACS,¹ Adil H. Haider, MD, MPH, FACS,⁵ Zara Cooper, MD, MSc, FACS,² Judith H. Lichtman, PhD³

1. Yale School of Medicine, New Haven, CT

2. Center for Surgery and Public Health: Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA

3. Yale School of Public Health, New Haven, CT

4. Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom

5. The Aga Khan University Medical College, Karachi, Pakistan

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Table S5. Tally of additional outcomes and extent of evidence for a July Effect

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Readmission

Study ID OR (95%CI) Weight (%)

Figure S1. Random-effects meta-analysis showing overall relative odds of readmission

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Mortality: Studies limited to ‘good’ and ‘exemplary’ studies

Figure S2. Random-effects meta-analysis showing overall relative odds of mortality limited to good/exemplary studies

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Mortality: Studies limited to last quarter comparator

Figure S3A. Random-effects meta-analysis showing overall relative odds of mortality stratified by timing of comparator (last quarter)

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Mortality: Studies limited to the remainder of the year

Figure S3B. Random-effects meta-analysis showing overall relative odds of mortality stratified by timing of comparator (remainder of the year)

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Mortality: Studies limited to surgical specialties

Figure S4A. Random-effects meta-analysis showing overall relative odds of mortality stratified by specialty (surgical specialties)

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Mortality: Studies limited to non-operative specialties

Figure S4B. Random-effects meta-analysis showing overall relative odds of mortality stratified by specialty (non-operative specialties)

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Mortality: Studies limited to United States-based studies

Figure S5A. Random-effects meta-analysis showing overall relative odds of mortality stratified by country of origin (United States)

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Mortality: Studies limited to international studies

Figure S5B. Random-effects meta-analysis showing overall relative odds of mortality stratified by country of origin (international)