Does resident hours reduction have an impact on surgical outcomes?
BACKGROUND
We assessed the impact of restricting surgical resident work hours as required by the Accreditation Council for Graduate Medical Education (ACGME), on postoperative outcomes.


METHODS
The divisions of General and Vascular Surgery at the Michael E. DeBakey Houston Veteran Affairs Medical Center implemented a limited work hours schedule effective October 1, 2002. We compared the rate of postoperative morbidity and mortality before and after the new schedule. Clinical data were collected by the VA National Surgical Quality Improvement Program (NSQIP) for the periods of October 1, 2001 to September 30, 2002 (preintervention), and October 1, 2002 to September 30, 2003 (postintervention). We assessed risk-adjusted observed to expected (O/E) ratios of mortality and prespecified postoperative morbidity for each study period.


RESULTS
In the preintervention period, there were 405 general surgery and 202 vascular surgery cases as compared to 382 and 208 cases, respectively in the postintervention period. There were no significant differences in mortality O/E ratios between the pre- and postintervention periods (0.63 versus 0.60 in general surgery; 0.78 versus 0.81 in vascular surgery; P = 0.90 and 0.94, respectively) or in morbidity O/E ratios (1.06 versus 1.27 in general surgery; 1.47 versus 1.50 in vascular surgery; P = 0.20 and 0.90, respectively).


CONCLUSIONS
The restricted resident work hour schedule in general and vascular surgery in our facility did not significantly affect postoperative outcomes.
Kaafarani
Haytham M A
HM
Michael E. DeBakey Veteran Affairs Medical Center, and Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Itani
Kamal M F
KM
Petersen
Laura A
LA
Thornby
John
J
Berger
David H
DH
D000068:Accreditation; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D017408:Guidelines as Topic; D006801:Humans; D007396:Internship and Residency; D011787:Quality of Health Care; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative / Q000401:mortality; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality; D016526:Workload