Resident Duty-Hour Reform Associated With Increased Complication Rate

New study links resident duty-hour reform to negative outcomes for hip
fracture patients

ROSEMONT, Ill., Sept. 2 /PRNewswire-USNewswire/ -- A new study finds a 2003
reform of the length of resident on-duty hours has led to an increase in the
rate of perioperative (the span of all three phases of surgery: before, during
and after) complications for patients treated for hip fractures. Among other
restrictions, this reform limited the resident workweek to 80 hours. The
resulting complications vary significantly, with an increasing rate of worse
outcomes seen in teaching hospitals, according to a study published in the
September 2009 issue of The Journal of Bone and Joint Surgery (JBJS).

"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. This may go against common assumptions regarding outcomes as they
relate to the length of resident hours," said study lead author James M.
Browne, MD, an orthopaedic surgeon currently completing a fellowship in
Rochester, Minnesota. The study was performed at Duke University Medical
Center.

On July 1, 2003, The Accreditation Council for Graduate Medical Education
implemented a resident duty-hour reform for all medical and surgical
residents, including orthopaedic resident surgeons, in the U.S. Dr. Browne
and his co-authors at Duke reviewed data from teaching and nonteaching
hospitals for 48,430 patients treated for hip fractures in a nationwide
inpatient sample database, reviewing two groups:
-- the first from 2001 and 2002 before resident duty-hour reform; and

-- the second in 2004 and 2005 after reform.

This study sought to measure changes in the rate of patient death or resulting
in-hospital complications since this reform. No increase in death rates was
found, but an increase in resulting negative outcomes was found in teaching
hospitals compared to nonteaching hospitals. The undesired results included
increases in the rate of:
-- pneumonia,
-- hematoma,
-- transfusion,
-- renal complications, and

-- nonroutine discharge.

In addition to an increase in the rate of medical complications, the study
also notes an increase in length and cost of stay in teaching hospitals.

"I think it would be premature for a patient to make any medical decisions
based on the results of this study. 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," said Dr. Browne.

A recent report from the Institute of Medicine proposes further limitations on
resident work hours.

"Surgeons and policy-makers need more data to understand the full impact of
these duty hour changes on our 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 number one priority," said Dr. Browne.

Disclosure: The authors did not receive any outside funding or grants in
support of their research for or preparation of this work. One or more of the
authors, or a member of his or her immediate family, received, in any one
year, payments or other benefits in excess of $10,000 or a commitment or
agreement to provide such benefits from commercial entities (Zimmer, DePuy,
and Wright Medical).

JBJS
AAOS
More information about the AAOS

SOURCE American Academy of Orthopaedic Surgeons

Kristina Findlay, +1-847-384-4034, findlay@aaos.org; or Lauren Pearson,
+1-847-384-4031, lpearson@aaos.org, both of AAOS