ACGME duty hour reform not associated with change in general surgery patient outcomes
In a quasi-experimental study of general surgery patient outcomes, results showed implementation of the 2011 Accreditation Council for Graduate Medical Education duty hour reform was not associated with a change in general surgery patient outcomes or differences in resident examination performance.
Researchers compared teaching and nonteaching hospitals using a difference-in-differences approach adjusted for procedural mix, patient comorbidities and time trends of general surgery patient outcomes 2 years before and after the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour reform. The main analysis consisted of 204,641 patients who underwent surgery at 23 teaching and 31 nonteaching hospitals participating in the American College of Surgeons National Surgical Quality improvement Program. For the same period, the researchers assessed general surgery resident performance on the annual in-training, written board and oral board examinations.
The study’s primary outcome measure was a composite of death or serious morbidity, and secondary outcomes included other postoperative complication and resident examination performance.
During the study period, results showed the unadjusted rate of death or serious morbidity improved in both teaching and nonteaching hospitals. The researchers found no association in the 2011 ACGME duty hour reform with a significant change in death or serious morbidity in either postreform year 1 or postreform year 2 or when both postreform years were combined during an adjusted analysis.
The researchers also found no association between duty hour reform and any other postoperative adverse outcome. From 2010 to 2013, no significant change was found in mean in-training examination scores for first-year residents, for resident from other postgraduate years or for first-time examinees taking the written or oral board examination during this period, according to the researchers.
“Our study suggests that these latest duty hour restrictions have no benefit and may actually have the unintended consequences of hurting patient safety, resident education and the doctor-patient relationship,” study author, Karl Y. Bilimoria, MD, MS, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine and a surgical oncologist at Northwestern Memorial Hospital, said in a press release. “They seriously disrupt the continuity of caring for surgical patients, which is vitally important, so we believe the recent 2011 rules should be repealed.”
Disclosure: The research was supported by the Agency for Healthcare Research and Quality, the American College of Surgeons Clinical Scholars in Residence Program and an educational grant from Merck.