title: Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek.
abstract: BACKGROUND
  In 2003, the Accreditation Council for Graduate Medical Education limited resident duty hours to 80 hours per week. More than a decade later, the effect of the limits on resident clinical competence is not fully understood.
  
  
  OBJECTIVE
  We sought to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery.
  
  
  METHODS
  We reviewed unlabored primary cesarean deliveries at Duke University Hospital after 34 weeks gestation, between 2003 and 2011. Descriptive statistics and linear regression were used to compare total operative time with incision to delivery time as a function of years since institution of the 80-hour workweek. Resident training level, subject body mass index, estimated blood loss, and skin closure method were controlled for in the regression model.
  
  
  RESULTS
  We identified 444 deliveries that met study criteria. The mean (SD) total operative time in 2003-2004 was 43.3 (14.3) minutes and 59.6 (10.7) minutes in 2010-2011 (P < .001). Multivariable regression demonstrated an increase in total operative time of 1.9 min/y (P < .001) but no change in incision to delivery time (P = .05). The magnitude of increased operative time was seen among junior residents (2.0 min/y, P < .001) compared to that of senior residents (1.2 min/y, P = .06).
  
  
  CONCLUSIONS
  Since introduction of the 2003 duty hour limits, there has been an increase of nearly 20 minutes in the time required for a routine cesarean delivery. It is unclear if the findings are due to a change in residency duty hours or to another aspect of residency training.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Smrtka
authors.forename: Ravindu P
authors.initials: RP
authors.lastname: Gunatilake
authors.forename: Benjamin
authors.initials: B
authors.lastname: Harris
authors.forename: Miao
authors.initials: M
authors.lastname: Yu
authors.forename: Lan
authors.initials: L
authors.lastname: Lan
authors.forename: Leo R
authors.initials: LR
authors.lastname: Brancazio
authors.forename: Fidel A
authors.initials: FA
authors.lastname: Valea
authors.forename: Chad A
authors.initials: CA
authors.lastname: Grotegut
authors.forename: Haywood L
authors.initials: HL
authors.lastname: Brown
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D009657:North Carolina; D009775:Obstetrics and Gynecology Department, Hospital; D061646:Operative Time; D010561:Personnel Staffing and Scheduling; D013997:Time Factors; D014940:Work Schedule Tolerance; D016526:Workload / Q000592:standards*