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Resident duty work-hour reform associated with increased complications
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New research from investigators at Duke University Medical Center links a recent reform of resident duty-hours to an increased rate of perioperative complications in patients undergoing hip fracture treatment.
The researchers also reported that teaching hospitals had a higher rate of worse outcomes for some complications compared to non-teaching hospitals.
“The data suggests a statistically significant increase in selected complications after implementation of the duty-hour reforms in teaching hospitals, where residents help deliver care, compared to non-teaching hospitals,” James M. Browne, MD, a lead author of the study and orthopedic surgeon completing a fellowship in Rochester, Minn., said in an American Association for Orthopaedic Surgeons (AAOS) press release. “This may go against common assumptions regarding outcomes as they relate to the length of resident hours.”
The study appears in the September issue of The Journal of Bone and Joint Surgery.
The resident duty-hour reform was implemented by the Accreditation Council for Graduate Medical Education in 2003 and limited the resident work week to 80 hours, according to the release.
To determine if the reform correlated with a change in the rate of patient death or in-hospital complications, Browne and his colleagues used a national inpatient sample database to review the information of 48,430 patients who were treated at teaching and non-teaching hospitals for hip fractures.
The investigators compared the data of patients treated before the reform (from 2001 to 2002) to a group treated after the reform was implemented (from 2004 to 2005).
Although the investigators found no significant increase in the rate of death after the reform, they discovered that teaching hospitals demonstrated higher rates of pneumonia, renal complications, transfusion, non-routine discharge and hematoma compared to those of non-teaching hospitals.
The investigators also found that the teaching hospitals had a longer length of stay and increased cost of stay compared to non-teaching hospitals.
Browne said the topic requires additional study.
“I think it would be premature for a patient to make any medical decisions based on the results of this study,” he said in the press release. “What this data does tell us is that this issue needs to be examined further. Remember, this is limited to hip fracture outcomes tracked during a limited time period and does not take into account any improvements in delivery of care since 2005.”
Browne also said that more data are needed to understand how changes in resident duty-hours impact patients.
“As we consider any kind of reform, we must continue to keep the safe delivery of care that results in successful patient outcomes as our No. 1 priority,” he said.
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