Impact of ACGME work-hour restrictions on the outcomes of coronary artery bypass grafting in a cohort of 600,000 patients.
BACKGROUND
Since the resident physician 80-h/wk restriction was implemented on July 1, 2003, little has been learned about the impact of this reform on patient outcomes after coronary artery bypass grafting (CABG).


METHODS
Using the Nationwide Inpatient Sample database, we identified 614,177 patients who underwent isolated CABG from 1998 through 2007. Of the 374,947 patients who underwent CABG at a teaching hospital, 133,285 (36%) belonged to the post-reform group. Hierarchic logistic and multivariable regression models were used to assess the independent effect of the reform after adjusting for potential confounding factors. Outcomes assessed were operative morbidity and mortality, and length of stay. Outcomes of CABG patients at non-teaching hospitals were used to control for time bias.


RESULTS
In teaching hospitals, after risk adjustment, the post-reform era was associated with lower mortality risk (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.56-0.63; P < 0.001) but greater operative morbidity (OR, 1.5; 95% CI, 1.43-1.58; P < 0.001). Although the implementation of work-hour reforms was correlated with shorter lengths of stay, there were fewer routine home discharges (OR, 0.73; 95% CI, 0.73-0.76; P < 0.001). Outcomes at non-teaching hospitals were similar, except that operative morbidity rates were lower during the post-reform era.


CONCLUSIONS
The implementation of the resident work-hour reform in teaching hospitals did not affect mortality rates in CABG patients but was associated with increased morbidity. Further studies are needed to identify the reasons for the post-reform increase in postoperative complications at teaching hospitals.
Gopaldas
Raja R
RR
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Chu
Danny
D
Dao
Tam K
TK
Huh
Joseph
J
LeMaire
Scott A
SA
Coselli
Joseph S
JS
Bakaeen
Faisal G
FG
D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome