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Resident Duty-Hour Reform associated with
increased complication rate
Newswise — A new study finds a 2003 reform
of the length of resident on-duty hours has
led to an increase in the rate of
perioperative (the span of all three phases
of surgery: before, during and after)
complications for patients treated for hip
fractures.
Among other restrictions, this reform
limited the resident workweek to 80 hours.
The resulting complications vary
significantly, with an increasing rate of
worse outcomes seen in teaching hospitals,
according to a study published in the
September 2009 issue of The Journal of
Bone and Joint Surgery (JBJS).
“The data suggests a statistically
significant increase in selected
complications after implementation of the
duty-hour reforms in teaching hospitals,
where residents help deliver care, compared
to non-teaching hospitals.
"This may go against common assumptions
regarding outcomes as they relate to the
length of resident hours,” said study lead
author James M. Browne, MD, an orthopaedic
surgeon currently completing a fellowship in
Rochester, Minnesota. The study was
performed at Duke University Medical Center.
On July 1, 2003, The Accreditation Council
for Graduate Medical Education implemented a
resident duty-hour reform for all medical
and surgical residents, including
orthopaedic resident surgeons, in the U.S.
Dr. Browne and his co-authors at Duke
reviewed data from teaching and nonteaching
hospitals for 48,430 patients treated for
hip fractures in a nationwide inpatient
sample database, reviewing two groups:
• the first from 2001 and 2002 before
resident duty-hour reform; and
• the second in 2004 and 2005 after reform.
This study sought to measure changes in the
rate of patient death or resulting
in-hospital complications since this reform.
No increase in death rates was found, but an
increase in resulting negative outcomes was
found in teaching hospitals compared to
nonteaching hospitals. The undesired results
included increases in the rate of:
• pneumonia,
• hematoma,
• transfusion,
• renal complications, and
• nonroutine discharge.
In addition to an increase in the rate of
medical complications, the study also notes
an increase in length and cost of stay in
teaching hospitals.
“I think it would be premature for a patient
to make any medical decisions based on the
results of this study. What this data does
tell us is that this issue needs to be
examined further.
" Remember, this is limited to hip fracture
outcomes tracked during a limited time
period and does not take into account any
improvements in delivery of care since
2005.” said Dr. Browne.
A recent report from the Institute of
Medicine proposes further limitations on
resident work hours.
“Surgeons and policy-makers need more data
to understand the full impact of these duty
hour changes on our patients.
"As we consider any kind of reform, we must
continue to keep the safe delivery of care
that results in successful patient outcomes
as our number one priority,” said Dr.
Browne.
Disclosure: The authors did not receive any
outside funding or grants in support of
their research for or preparation of this
work. One or more of the authors, or a
member of his or her immediate family,
received, in any one year, payments or other
benefits in excess of $10,000 or a
commitment or agreement to provide such
benefits from commercial entities (Zimmer,
DePuy, and Wright Medical).
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