T. Feeney2, J. Havens1 1Brigham And Women’s Hospital,Trauma,Boston, MA, USA 2Harvard School Of Public Health,Boston, MA, USA
Introduction: Resident duty hour reform was implemented in 2003 and further modified in 2011. The effect of these changes on patient outcomes remains unclear. We investigated the effect on outcomes of resident involvement in surgical procedures over time since these changes have been implemented. We hypothesized that there has been no change in outcomes since implementation of the resident work hours restrictions.
Methods: We utilized the ACS-NSQIP database (2005-2012). General surgery were identified by common procedural terminology code, and were restricted to ages ≥18. Using 2005/2006 as reference logistic and linear regression analysis was performed.
Results:There were 422,733 procedures analyzed. In the attending only group there was no difference in the odds of major morbidity in 2012 (Odds Ratio (OR) (0.67 (95% Confidence Interval 0.35-1.31;p=0.247)), overall morbidity (0.86 (0.63-1.18;p=0.354)) or all-cause mortality(0.40(0.09-1.87;p=0.246)). In cases that included a trainee there was no change in the odds of major morbidity in 2012(OR 1.42(0.77-2.62;p=0.264)), the odds of overall morbidity (OR 1.12(0.81-1.53;p=0.495)) or the odds of all-cause mortality (OR 2.20(0.46-10.49;p=0.322)) over the same time period. There was an increase in mean operative time the attending only cases from 2005 to 2012 (14.7 min(10.8- 18.6;p<0.001), but there was a decrease of 7.48 min(11.0-3.9;p<0.001)in the mean operating time in the cases that included a trainee.
Conclusion: Between 2005-2012 there were no changes in the odds of overall complications, major complications, or all-cause mortality in surgeries involving attending surgeons only or involving trainees. There has been a significant change in the mean operative time in both groups. Attending surgeons operating alone had an increase in operative time while cases that included a trainee had a decrease in operative time. These data suggest that while operative time has changed, surgical outcomes for patients have not changed between 2005 and 2012.