July 30, 2015 / 7:05 PM / 4 years ago

Cutting junior doctors’ hours may not lower risk of surgical deaths

(Reuters Health) - Restrictions on U.S. medical residents’ hours implemented in 2011 don’t appear to have significantly lowered the risk of death or serious injury from surgery, a recent study suggests.

Researchers compared data on surgical outcomes one year before the duty hour reforms and two years afterwards for five specialties: neurosurgery, obstetrics/gynecology, orthopedics, urology and vascular surgery. While rates of death and injury did decline over the study period, the changes were so small they might have been due to chance.

Over the past decade, concern for patient safety and the wellbeing of doctors in training, known as residents, has driven reductions in work hours and more rest between shifts for residents.

But these changes have in turn raised questions about whether more frequent handoffs of patient care from one clinician to the next might lead to mistakes, said lead study author Dr. Ravi Rajaram, a researcher at the American College of Surgeons and Northwestern University’s Feinberg School of Medicine in Chicago.

“While reducing resident hours may intuitively suggest that patient care may improve, these potential gains may in part be mitigated by communication failures and adverse events stemming from increased transitions in patient care” Rajaram said by email.

The most recent reforms in 2011 limited first-year residents to 16-hour shifts and also mandated eight hours off between work periods for all residents, as well as 14-hour breaks after 24-hour shifts.

Rajaram and colleagues analyzed data from a national registry of surgical outcomes, adjusting for individual patient circumstances to see how the 2011 reforms impacted the odds that patients died or developed serious complications within 30 days of their procedures.

The study included roughly 194,000 surgical cases from July 2010 through June 2013.

Complications included problems such as surgical site infections, pneumonia, heart attacks, sepsis or unplanned repeat operations.

Before adjusting for patient circumstances, the rates of deaths and complications declined for all five surgical specialties studied, in both teaching and non-teaching hospitals.

But once researchers accounted for the complexities of each surgery, the duty hour reforms weren’t associated with a reduction in deaths or serious complications for any of the specialties.

The findings are in line with other recent research that suggests reforming resident hours doesn’t do much to improve or worsen patient care, said Dr. Kevin Imrie, president of the Royal College of Physicians and Surgeons of Canada and physician-in-chief at Sunnybrook Health Sciences Center in Toronto.

After two years, any positive effect of the reforms should be clear, Imrie, who wasn’t involved in the study, said by email. The lack of improved outcomes highlights some of the particular challenges of implementing reforms for surgical residents, he added.

“Competence is gained through repeated exposure to treating and operating on sick patients, and the care of patients does risk being disrupted by the frequent transfers of care from one doctor to another if hours are reduced,” Imrie said.

The current study adds to a growing body of evidence suggesting that some reforms of duty hours have gone too far, potentially harming both patient care and resident education, said Dr. Karl Bilimoria, director of the surgical outcomes and quality improvement center at Northwestern University’s Feinberg School of Medicine in Chicago.

“The new policies are no safer,” Bilimoria, who wasn’t involved in the study, said by email. “In the face of other evidence and objections from an overwhelming majority, strategically repealing some of the duty hour reforms is merited.”

SOURCE: bit.ly/1SkMeWv Journal of the American College of Surgeons, online July 7, 2015.

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