Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident workweek.
BACKGROUND
Considerable concern has been raised about the effects of restricted duty hours on surgical training. However, to our knowledge, the effect of the 80-hour resident workweek on operative outcomes after laparoscopic cholecystectomy has not been well studied.


OBJECTIVE
To compare the rates of bile duct injury and overall complications after laparoscopic cholecystectomy before and after the institution of the duty-hour restriction.


METHODS
Retrospective review of patient medical records to determine morbidity and mortality before (January 1, 2000, to June 30, 2003; period 1) and after (July 1, 2003, to June 30, 2006; period 2) implementation of duty hour limitations.


METHODS
Major public teaching hospital.


METHODS
A total of 2470 patients who had undergone laparoscopic cholecystectomy.


METHODS
Bile duct injury and overall complication rates as determined using multivariate analysis.


RESULTS
Overall, 2470 laparoscopic cholecystectomy procedures were performed, including 1353 in period 1 and 1117 in period 2. In period 2, more patients had acute cholecystitis as the indication for surgery (49% vs 35% in period 1, P < .001), and a higher percentage of patients were male (22% vs 18%, P = .01). The incidence of bile duct injury and total complications decreased in period 2 from 1% to 0.4%(P = .04) and from 5% to 2% (P < .001), respectively. Mortality was unchanged. Multivariate analysis revealed that period 2 was protective for bile duct injury (odds ratio, 0.31; 95% confidence interval, 0.1-0.96; P = .04). For complications, both female sex (odds ratio, 0.62; 95% confidence interval, 0.38-0.9) and surgery during period 2 (odds ratio, 0.46; 95% confidence interval, 0.28-0.75) were protective, whereas older age (odds ratio, 1.03; 95% confidence interval, 1.02-1.05) was associated with complications.


CONCLUSIONS
At a major public teaching hospital, the bile duct injury rate and the overall complication rate decreased after implementation of the 80-hour workweek.
Yaghoubian
Arezou
A
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
Saltmarsh
Guy
G
Rosing
David K
DK
Lewis
Roger J
RJ
Stabile
Bruce E
BE
de Virgilio
Christian
C
D000328:Adult; D001652:Bile Ducts / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000592:standards; D005260:Female; D013502:General Surgery / Q000193:education / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D014481:United States