Association of the 2011 ACGME Resident Duty Hour Reform with Postoperative Patient Outcomes in Surgical Specialties

Ravi Rajaram, Jeanette W. Chung, Mark E. Cohen, Allison R. Dahlke, Anthony D. Yang, Joshua J. Meeks, Clifford Y. Ko, John L. Tarpley, David B. Hoyt, Karl Y. Bilimoria

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background The 2011 ACGME resident duty hour reform implemented additional restrictions to existing duty hour policies. Our objective was to determine the association between this reform and patient outcomes among several surgical specialties. Study Design Patients from 5 surgical specialties (neurosurgery, obstetrics/gynecology, orthopaedic surgery, urology, and vascular surgery) were identified from the American College of Surgeons NSQIP. Data from 1 year before and 2 years after the reform was implemented were obtained for teaching and nonteaching hospitals. Hospital teaching status was defined based on the percentage of operations with a resident present intraoperatively. Difference-in-differences models were developed separately for each specialty and adjusted for patient demographics, comorbidities, procedural case-mix, and time trends. The association between duty hour reform and a composite measure of death or serious morbidity within 30 days of surgery was estimated for each specialty. Results The unadjusted rate of death or serious morbidity decreased during the study period in both teaching and nonteaching hospitals for all surgical specialties. In multivariable analyses, there were no significant associations between duty hour reform and the composite outcomes of death or serious morbidity in the 2 years post-reform for any surgical specialty evaluated (neurosurgery: odds ratio [OR] = 0.90; 95% CI, 0.75-1.08; p = 0.26; obstetrics/gynecology: OR = 0.96; 95% CI, 0.71-1.30; p = 0.80; orthopaedic surgery: OR = 0.95; 95% CI, 0.74-1.22; p = 0.70; urology: OR = 1.16; 95% CI, 0.89-1.51; p = 0.26; vascular surgery: OR = 1.07; 95% CI, 0.93-1.22; p = 0.35). Conclusions Implementation of the 2011 ACGME resident duty hour reform was not associated with a significant change in patient outcomes for several surgical specialties in the 2 years after reform.

Original languageEnglish (US)
Article number7933
Pages (from-to)748-757
Number of pages10
JournalJournal of the American College of Surgeons
Volume221
Issue number3
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

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Surgical Specialties
Odds Ratio
Teaching Hospitals
Neurosurgery
Urology
Morbidity
Gynecology
Obstetrics
Orthopedics
Blood Vessels
Diagnosis-Related Groups
Ambulatory Surgical Procedures
Comorbidity
Demography
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Rajaram, R., Chung, J. W., Cohen, M. E., Dahlke, A. R., Yang, A. D., Meeks, J. J., ... Bilimoria, K. Y. (2015). Association of the 2011 ACGME Resident Duty Hour Reform with Postoperative Patient Outcomes in Surgical Specialties. Journal of the American College of Surgeons, 221(3), 748-757. [7933]. https://doi.org/10.1016/j.jamcollsurg.2015.06.010

Association of the 2011 ACGME Resident Duty Hour Reform with Postoperative Patient Outcomes in Surgical Specialties. / Rajaram, Ravi; Chung, Jeanette W.; Cohen, Mark E.; Dahlke, Allison R.; Yang, Anthony D.; Meeks, Joshua J.; Ko, Clifford Y.; Tarpley, John L.; Hoyt, David B.; Bilimoria, Karl Y.

In: Journal of the American College of Surgeons, Vol. 221, No. 3, 7933, 01.09.2015, p. 748-757.

Research output: Contribution to journalArticle

Rajaram, R, Chung, JW, Cohen, ME, Dahlke, AR, Yang, AD, Meeks, JJ, Ko, CY, Tarpley, JL, Hoyt, DB & Bilimoria, KY 2015, 'Association of the 2011 ACGME Resident Duty Hour Reform with Postoperative Patient Outcomes in Surgical Specialties', Journal of the American College of Surgeons, vol. 221, no. 3, 7933, pp. 748-757. https://doi.org/10.1016/j.jamcollsurg.2015.06.010
Rajaram, Ravi ; Chung, Jeanette W. ; Cohen, Mark E. ; Dahlke, Allison R. ; Yang, Anthony D. ; Meeks, Joshua J. ; Ko, Clifford Y. ; Tarpley, John L. ; Hoyt, David B. ; Bilimoria, Karl Y. / Association of the 2011 ACGME Resident Duty Hour Reform with Postoperative Patient Outcomes in Surgical Specialties. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 3. pp. 748-757.
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abstract = "Background The 2011 ACGME resident duty hour reform implemented additional restrictions to existing duty hour policies. Our objective was to determine the association between this reform and patient outcomes among several surgical specialties. Study Design Patients from 5 surgical specialties (neurosurgery, obstetrics/gynecology, orthopaedic surgery, urology, and vascular surgery) were identified from the American College of Surgeons NSQIP. Data from 1 year before and 2 years after the reform was implemented were obtained for teaching and nonteaching hospitals. Hospital teaching status was defined based on the percentage of operations with a resident present intraoperatively. Difference-in-differences models were developed separately for each specialty and adjusted for patient demographics, comorbidities, procedural case-mix, and time trends. The association between duty hour reform and a composite measure of death or serious morbidity within 30 days of surgery was estimated for each specialty. Results The unadjusted rate of death or serious morbidity decreased during the study period in both teaching and nonteaching hospitals for all surgical specialties. In multivariable analyses, there were no significant associations between duty hour reform and the composite outcomes of death or serious morbidity in the 2 years post-reform for any surgical specialty evaluated (neurosurgery: odds ratio [OR] = 0.90; 95{\%} CI, 0.75-1.08; p = 0.26; obstetrics/gynecology: OR = 0.96; 95{\%} CI, 0.71-1.30; p = 0.80; orthopaedic surgery: OR = 0.95; 95{\%} CI, 0.74-1.22; p = 0.70; urology: OR = 1.16; 95{\%} CI, 0.89-1.51; p = 0.26; vascular surgery: OR = 1.07; 95{\%} CI, 0.93-1.22; p = 0.35). Conclusions Implementation of the 2011 ACGME resident duty hour reform was not associated with a significant change in patient outcomes for several surgical specialties in the 2 years after reform.",
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AU - Chung, Jeanette W.

AU - Cohen, Mark E.

AU - Dahlke, Allison R.

AU - Yang, Anthony D.

AU - Meeks, Joshua J.

AU - Ko, Clifford Y.

AU - Tarpley, John L.

AU - Hoyt, David B.

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N2 - Background The 2011 ACGME resident duty hour reform implemented additional restrictions to existing duty hour policies. Our objective was to determine the association between this reform and patient outcomes among several surgical specialties. Study Design Patients from 5 surgical specialties (neurosurgery, obstetrics/gynecology, orthopaedic surgery, urology, and vascular surgery) were identified from the American College of Surgeons NSQIP. Data from 1 year before and 2 years after the reform was implemented were obtained for teaching and nonteaching hospitals. Hospital teaching status was defined based on the percentage of operations with a resident present intraoperatively. Difference-in-differences models were developed separately for each specialty and adjusted for patient demographics, comorbidities, procedural case-mix, and time trends. The association between duty hour reform and a composite measure of death or serious morbidity within 30 days of surgery was estimated for each specialty. Results The unadjusted rate of death or serious morbidity decreased during the study period in both teaching and nonteaching hospitals for all surgical specialties. In multivariable analyses, there were no significant associations between duty hour reform and the composite outcomes of death or serious morbidity in the 2 years post-reform for any surgical specialty evaluated (neurosurgery: odds ratio [OR] = 0.90; 95% CI, 0.75-1.08; p = 0.26; obstetrics/gynecology: OR = 0.96; 95% CI, 0.71-1.30; p = 0.80; orthopaedic surgery: OR = 0.95; 95% CI, 0.74-1.22; p = 0.70; urology: OR = 1.16; 95% CI, 0.89-1.51; p = 0.26; vascular surgery: OR = 1.07; 95% CI, 0.93-1.22; p = 0.35). Conclusions Implementation of the 2011 ACGME resident duty hour reform was not associated with a significant change in patient outcomes for several surgical specialties in the 2 years after reform.

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