Higher complications and no improvement in mortality in the ACGME resident duty-hour restriction era: an analysis of more than 107,000 neurosurgical trauma patients in the Nationwide Inpatient Sample database.
BACKGROUND
The Accreditation Council for Graduate Medical Education resident duty-hour restrictions were implemented in July 2003 based on the supposition that resident fatigue contributes to medical errors.


OBJECTIVE
To examine the effect of duty-hour restrictions on outcome in neurotrauma patients.


METHODS
The Nationwide Inpatient Sample database was analyzed for a time period with no restrictions (years 1999-2002) compared with a period with restrictions (years 2005-2008) for (1) mortality and (2) complications. We analyzed both teaching and nonteaching hospitals to account for potential differences attributed to non-resident-related factors.


RESULTS
There were 107,006 teaching hospital and 115,604 nonteaching hospital admissions for neurotrauma. Multivariate logistic regression demonstrated significantly more complications in the time period with restrictions in teaching hospitals. In nonteaching hospitals, there was no difference in complications. In both teaching and nonteaching hospitals, there was no difference in mortality between the 2 time periods. For teaching and nonteaching hospitals, there was no difference in hospital length of stay, but hospital charges were significantly higher in the period with restrictions. The occurrence of a complication was significantly associated with longer hospital length of stay and higher hospital charges in both time periods in both teaching and nonteaching hospitals.


CONCLUSIONS
The implementation of the Accreditation Council for Graduate Medical Education resident duty-hour restrictions was associated with increased complications and no change in mortality for neurotrauma patients in teaching hospitals. In nonteaching hospitals, there was no change in complications and mortality. The occurrence of a complication was associated with longer length of stay and higher hospital charges in both time periods in both teaching and nonteaching hospitals.
Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA. brian.hoh@neurosurgery.ufl.edu
Brian L
BL
Hoh
Daniel W
DW
Neal
Dominic T
DT
Kleinhenz
Daniel J
DJ
Hoh
J
J
Mocco
Fred G
FG
Barker
D016208:Databases, Factual; D004503:Education, Medical, Graduate / Q000592:standards; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D009493:Neurosurgery; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality*; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D000078329:Workforce; D014947:Wounds and Injuries / Q000601:surgery