The impact of resident work-hour restrictions on outcomes of cardiac operations.
BACKGROUND
The Accreditation Council of Graduate Medical Education mandated an 80-h/wk resident physician work-hour restriction on July 1, 2003. The objective of this study was to evaluate the impact of the resident work-hour restriction on outcomes of cardiac operations.


METHODS
We reviewed records of 1562 patients who underwent cardiac operations at our institution between 1997 and 2007, and we compared outcomes of operations performed before July 1, 2003 (pre-reform, n=777) and those performed after July 1, 2003 (post-reform, n=785). Multivariate analysis with logistic regression was used to test for the independent effects of the resident work-hour reform by controlling for patient-specific confounding factors.


RESULTS
Post-reform patients had a significantly lower 30-d mortality rate (1.8% versus 3.9%; P=0.01) and a slightly lower 6-month mortality rate (4.5% versus 6.3%; P=0.12) than pre-reform patients. Multivariate analysis revealed that the post-reform patients had significantly lower adjusted 30-d mortality (odds ratio, 0.37; 95% CI, 0.18-0.75; P=0.006) and 6-mo mortality (odds ratio, 0.56; 95% CI, 0.34-0.91; P=0.02) than the pre-reform patients.


CONCLUSIONS
Cardiac operations performed after the resident work-hour restriction went into effect were associated with significantly lower adjusted 30-d and 6-mo mortality rates than were operations performed before the work-hour restriction became effective.
Gopaldas
Raja R
RR
Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Huh
Joseph
J
Bakaeen
Faisal G
FG
Wang
Xing Li
XL
Coselli
Joseph S
JS
LeMaire
Scott A
SA
Chu
Danny
D
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D004502:Education, Medical, Continuing; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D014940:Work Schedule Tolerance / Q000523:psychology*