C. Scally1, A. Ryan2, J. Thumma1, P. Gauger1, J. Dimick1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2Weill Cornell Medical College,Healthcare Policy & Research,New York, NY, USA
Introduction: In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented an additional set of restrictions on resident work hours. The implications of these regulations for the education of surgical trainees has been a subject of significant scrutiny, but the effect on patient outcomes is unknown.
Methods: We used national Medicare claims data for patients undergoing common general (n = 1, 223, 815) and vascular (n = 475, 262) surgery procedures in two time periods, the 3 years immediately preceding the duty hour changes (January 2009 – June, 2011), and the 18 months following (July 2011 – December 2012). Hospitals were stratified into quintiles of teaching intensity using a resident-to-bed ratio. To account for other changes in surgical outcomes over this period, we used a control group of non-teaching hospitals. We then utilized a difference-in-differences analytic technique to compare risk adjusted 30-day mortality, morbidity, reoperation, and readmission rates prior to and following the duty hour changes.
Results: Following duty hour reform, no significant changes were seen in any of our measured outcomes when comparing teaching to non-teaching hospitals. Even when hospitals were stratified by teaching intensity there were no significant differences. For example, at the highest intensity teaching hospitals (resident to bed ratio ≥ .6), mortality rates before and after the duty hour changes were 4.2% and 4.0% respectively, compared to 4.7% and 4.4% for non-teaching hospitals (OR .98, 95% CI .89-1.07). Similarly, complication (OR 1.01, 95% CI .97-1.06), reoperation (OR 1.01, 95% CI .80-1.26), and readmission (OR .99, 95% CI .95-1.04) rates were unchanged between the two time periods.
Conclusion: In the immediate period following the 2011 ACGME duty hour changes, no significant improvement in outcomes was seen among Medicare beneficiaries undergoing common general and vascular surgery operations at teaching hospitals.