title: Early impact of the 2011 ACGME duty hour regulations on surgical outcomes.
abstract: BACKGROUND
  In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented additional restrictions on resident work hours. Although the impact of these restrictions on the education of surgical trainees has been examined, the effect on patient safety remains poorly understood.
  
  
  METHODS
  We used national Medicare Claims data for patients undergoing general (n = 1,223,815) and vascular (n = 475,262) surgery procedures in the 3 years preceding the duty hour changes (January, 2009-June, 2011) and the 18 months thereafter (July, 2011-December, 2012). Hospitals were stratified into quintiles by teaching intensity using a resident to bed ratio. We utilized a difference-in-differences analytic technique, using nonteaching hospitals as a control group, to compare risk-adjusted 30-day mortality, serious morbidity, readmission, and failure to rescue (FTR) rates before and after the duty hour changes.
  
  
  RESULTS
  After duty hour reform, no changes were seen in the measured outcomes when comparing teaching with nonteaching hospitals. Even when stratifying by teaching intensity, there were no differences. For example, at the highest intensity teaching hospitals (resident/bed ratio of ≥ 0.6), mortality rates before and after the duty hour changes were 4.2% and 4.0%, compared with 4.7% and 4.4% for nonteaching hospitals (relative risk [RR], 0.98; 95% CI, 0.89-1.07). Similarly, serious complication (RR, 1.02; 95% CI, 0.98-1.06), FTR (RR, 0.95; 95% CI, 0.87-1.04), and readmission (odds ratio, 1.00; 95% CI, 0.96-1.03) rates were unchanged.
  
  
  CONCLUSIONS
  In Medicare beneficiaries undergoing surgery at teaching hospitals, outcomes have not improved since the 2011 ACGME duty hour regulations.
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI; General Surgery Residency Program, Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: cscally@med.umich.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Scally
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ryan
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Jyothi R
authors.initials: JR
authors.lastname: Thumma
authors.affiliation: General Surgery Residency Program, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Gauger
authors.affiliation: Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D000068:Accreditation / Q000592:standards*; D000368:Aged; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000592:standards*; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007342:Insurance Benefits / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload / Q000592:standards*