title: The effect of duty hour regulations on outcomes of neurological surgery in training hospitals in the United States: duty hour regulations and patient outcomes.
abstract: OBJECTIVE
  The effects of sleep deprivation on performance have been well documented and have led to changes in duty hour regulation. New York State implemented stricter duty hours in 1989 after sleep deprivation among residents was thought to have contributed to a patient's death. The goal of this study was to determine if increased regulation of resident duty hours results in measurable changes in patient outcomes.
  
  
  METHODS
  Using the Nationwide Inpatient Sample (NIS), patients undergoing neurosurgical procedures at hospitals with neurosurgery training programs were identified and screened for in-hospital complications, in-hospital procedures, discharge disposition, and in-hospital mortality. Comparisons in the above outcomes were made between New York hospitals and non-New York hospitals before and after the Accreditation Council for Graduate Medical Education (ACGME) regulations were put into effect in 2003.
  
  
  RESULTS
  Analysis of discharge disposition demonstrated that 81.9% of patients in the New York group 2000-2002 were discharged to home compared with 84.1% in the non-New York group 2000-2002 (p = 0.6, adjusted multivariate analysis). In-hospital mortality did not significantly differ (p = 0.7). After the regulations were implemented, there was a nonsignificant decrease in patients discharged to home in the non-New York group: 84.1% of patients in the 2000-2002 group compared with 81.5% in the 2004-2006 group (p = 0.6). In-hospital mortality did not significantly change (p = 0.9). In New York there was no significant change in patient outcomes with the implementation of the regulations; 81.9% of patients in the 2000-2002 group were discharged to home compared with 78.0% in the 2004-2006 group (p = 0.3). In-hospital mortality did not significantly change (p = 0.4). After the regulations were in place, analysis of discharge disposition demonstrated that 81.5% of patients in the non-New York group 2004-2006 were discharged to home compared with 78.0% in the New York group 2004-2006 (p = 0.01). In-hospital mortality was not significantly different (p = 0.3).
  
  
  CONCLUSIONS
  Regulation of resident duty hours has not resulted in significant changes in outcomes among neurosurgical patients.
authors.affiliation: Department of Surgery, Hennepin County Medical Center;
authors.forename: Kiersten
authors.initials: K
authors.lastname: Norby
authors.forename: Farhan
authors.initials: F
authors.lastname: Siddiq
authors.forename: Malik M
authors.initials: MM
authors.lastname: Adil
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Haines
mesh_terms: D000068:Accreditation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004503:Education, Medical, Graduate / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D009518:New York; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: ACGME = Accreditation Committee on Graduate Medical Education; ACGME residency regulations; AHRQ = Agency for Healthcare Research and Quality; APR-DRG = All Patient Refined Diagnosis Related Group; HCUP = Healthcare Cost and Utilization Project; ICH = intracerebral hemorrhage; LOS = length of stay; MI = myocardial infarction; NIS = Nationwide Inpatient Sample; SEER = Surveillance, Epidemiology, and End Results; UTI = urinary tract infection; neurosurgery; patient outcomes