Fewer patients undergoing gallbladder surgery at one major public teaching hospital sustained injuries to their bile ducts or other complications after resident physicians' work hours were limited to 80 per week, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals.
Concerns about patient safety and resident well-being led to the implementation of the 80-hour workweek in July 2003, according to background information in the article. "However, some surgical educators have expressed misgivings about the restricted hours because of more frequent shift changes, decreased patient exposure for residents, interruption in continuity of care and increased potential for communication breakdown," the authors write.
Arezou Yaghoubian, M.D., and colleagues at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif., analyzed the medical records of 2,470 patients who underwent laparoscopic cholecystectomy (gallbladder removal)—a procedure commonly performed by surgical residents nationwide—before and after the duty hour limitations. "Previous studies using simulators have indicated that sleep deprivation has substantial adverse effects on laparoscopic skills in residents," the authors write. "Bile duct injury [a common complication of cholecystectomy, in which the tubes that transport fluids between the liver and gallbladder are damaged] has a potentially devastating long-term adverse effect on the patient."
Overall, 1,353 procedures were performed before the 80-hour workweek implementation (January 2000 to June 2003) and 1,117 afterward (July 2003 to June 2006). After the restrictions, fewer patients experienced bile duct injury (0.4 percent vs. 1 percent) or any complication (2 percent vs. 5 percent). Analyses revealed that having surgery during the second time period was associated with reduced odds of bile duct injury and of total complications.
"The complication rate in period two decreased despite there being a higher percentage of patients with acute cholecystitis and a greater percentage of male patients, both of which have been shown to be associated with a higher risk of bile duct injury," the authors write.
"In conclusion, we observed improved outcomes in the era of restricted resident work hours in patients undergoing laparoscopic cholecystectomy," they continue. "Despite the concerns that work hour restrictions may have deleterious effects on patient care and resident education, these results clearly indicate otherwise. Whether the better-rested resident surgeon leads to better surgical outcomes needs further study."
- Arezou Yaghoubian; Guy Saltmarsh; David K. Rosing; Roger J. Lewis; Bruce E. Stabile; Christian de Virgilio. Decreased Bile Duct Injury Rate During Laparoscopic Cholecystectomy in the Era of the 80-Hour Resident Workweek. Arch Surg, 2008; 143 (9): 847-851
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