Featured Research

from universities, journals, and other organizations

Limiting neurosurgery residents' work hours hasn't decreased complication rates

Date:
November 19, 2012
Source:
Wolters Kluwer Health: Lippincott Williams & Wilkins
Summary:
Limits on duty hours for residents in training haven't increased the safety of one common brain operation, concludes a new study.

Limits on duty hours for residents in training haven't increased the safety of one common brain operation, concludes a study in the November issue of Neurosurgery, official journal of the Congress of Neurological Surgeons.

Hospitals that train neurosurgery residents have had an uptick in complication rates since the work-hour limits were introduced, according to the study led by Drs. Anand I. Rughani, of the University of Toronto, and Travis M. Dumont of University of Buffalo, N.Y. The findings raise concerns that limiting residents' work hours may have contributed to increased complication rates, at least indirectly.

Have Work Limits Affected Neurosurgery Complication Rates?

The study was designed to evaluate the patient safety impact of rules limiting the hours worked by residents, introduced in 2003. The goal of the limits -- a maximum of 88 hours per week -- was to reduce the risk of errors and injury related to resident fatigue.

The researchers analyzed data from a nationwide hospital database from 1998-2002 and 2004-2008 -- five years before and five years after the new work-hour rules. The study focused on surgery to remove benign brain tumors called meningiomas -- a common neurosurgery procedure that did not significantly change in other ways during the periods studied.

Complication rates were assessed for more than 21,000 patients. The study looked at complications not only at teaching hospitals where residents work and train, but also in non-teaching hospitals, which don't train residents.

The data from teaching hospitals showed a significant increase in complication rates after the work-hour limits were introduced: from 14 percent in 1998-2002 to 16 percent in 2004-2008. In contrast, complication rates at non-teaching hospitals remained "nearly constant" -- fifteen percent during both time periods.

The increase in complications at teaching hospitals remained significant after adjustment for other known risk factors -- especially age and medical illnesses.

Ongoing Debate on Impact of Limiting Duty Hours

The findings add a new piece of evidence to the ongoing debate over the impact of work-hour limits -- particularly for neurosurgery residents. Last year, Neurosurgery published a survey study which found that neurosurgery trainees strongly opposed the new limits. Residents felt that working fewer hours had a negative effect on their training opportunities.

The new study shows that, at least for one common neurosurgery procedure, limiting residents' work hours has not increased patient safety. Instead, complication rates actually increased in the years after the new rules were introduced.

Has the increase in complications occurred because residents have less surgical experience? Not necessarily, according to the authors. Other factors, especially age and medical illness, remain strong predictors of complications. Yet it's possible that the limits could have affected risk in other ways -- possibly by leading to "increased patient hand-offs, decreased continuity of care, and thus [increased] errors related to postoperative patient care."

"We would not argue with the idea that fatigue or sleep deprivation contribute to decreases in performance, but the relative contributions of these factors must be carefully weighed against the perhaps more pervasive effects of increased patient hand-offs, increased provider turnover, and decreased familiarity with patients, " says Dr. Rughani.

Dr. Dumont and coauthors believe their study "raises questions about the relationship between work-hour restrictions and clinical care." They discuss the results in light of other studies showing decreased "academic productivity" by residents -- including lower performance on written exams. The researchers conclude, "It could be argued that duty-hour regulation has exerted a common influence across the spectrum of academic, scientific, and clinical activities and performance."


Story Source:

The above story is based on materials provided by Wolters Kluwer Health: Lippincott Williams & Wilkins. Note: Materials may be edited for content and length.


Journal Reference:

  1. Travis M. Dumont, Bruce I. Tranmer, Michael A. Horgan, Anand I. Rughani. Trends in Neurosurgical Complication Rates at Teaching vs Nonteaching Hospitals Following Duty-Hour Restrictions. Neurosurgery, 2012; 71 (5): 1041 DOI: 10.1227/NEU.0b013e31826cdd73

Cite This Page:

Wolters Kluwer Health: Lippincott Williams & Wilkins. "Limiting neurosurgery residents' work hours hasn't decreased complication rates." ScienceDaily. ScienceDaily, 19 November 2012. <www.sciencedaily.com/releases/2012/11/121119132106.htm>.
Wolters Kluwer Health: Lippincott Williams & Wilkins. (2012, November 19). Limiting neurosurgery residents' work hours hasn't decreased complication rates. ScienceDaily. Retrieved July 22, 2014 from www.sciencedaily.com/releases/2012/11/121119132106.htm
Wolters Kluwer Health: Lippincott Williams & Wilkins. "Limiting neurosurgery residents' work hours hasn't decreased complication rates." ScienceDaily. www.sciencedaily.com/releases/2012/11/121119132106.htm (accessed July 22, 2014).

Share This




More Health & Medicine News

Tuesday, July 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

TheStreet (July 21, 2014) New research shows Gilead Science's drug Sovaldi helps in curing hepatitis C in those who suffer from HIV. In a medical study, the combination of Gilead's Hep C drug with anti-viral drug Ribavirin cured 76% of HIV-positive patients suffering from the most common hepatitis C strain. Hepatitis C and related complications have been a top cause of death in HIV-positive patients. Typical medication used to treat the disease, including interferon proteins, tended to react badly with HIV drugs. However, Sovaldi's %1,000-a-pill price tag could limit the number of patients able to access the treatment. TheStreet's Keris Lahiff reports from New York. Video provided by TheStreet
Powered by NewsLook.com
$23.6 Billion Awarded To Widow In Smoking Lawsuit

$23.6 Billion Awarded To Widow In Smoking Lawsuit

Newsy (July 20, 2014) Cynthia Robinson claims R.J. Reynolds Tobacco Company hid the health and addiction risks of its products, leading to the death of her husband in 1996. Video provided by Newsy
Powered by NewsLook.com
Tooth Plaque Provides Insight Into Diets Of Ancient People

Tooth Plaque Provides Insight Into Diets Of Ancient People

Newsy (July 19, 2014) Research on plaque from ancient teeth shows that our prehistoric ancestor's had a detailed understanding of plants long before developing agriculture. Video provided by Newsy
Powered by NewsLook.com
Contaminated Water Kills 3 Babies in South African Town

Contaminated Water Kills 3 Babies in South African Town

AFP (July 18, 2014) Contaminated water in South Africa's northwestern town of Bloemhof kills three babies and hospitalises over 500 people. The incident highlights growing fears over water safety in South Africa. Duration: 02:22 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins