Impact of the 80-hour workweek on patient care at a level I trauma center

Ali Salim, Pedro G R Teixeira, Linda Chan, Didem Oncel, Kenji Inaba, Carlos Brown, Peter Rhee, Thomas V Berne
Archives of Surgery 2007, 142 (8): 708-12; discussion 712-4

HYPOTHESIS: The 80-hour workweek limitation for surgical residents is associated with an increase in mortality and complication rates among adult trauma surgical patients.

DESIGN: Retrospective cohort study.

SETTING: Academic level I trauma center.

PATIENTS: Trauma patients admitted before and after the 80-hour workweek limitation.

METHODS: We compared death and complication rates for adult trauma patients admitted during a 24-month period before (2001-2003) and a 24-month period after (2004-2006) implementation of the 80-hour workweek at our institution. Relative risk and its 95% confidence intervals were examined.

MAIN OUTCOME MEASURES: Patient care outcomes included preventable and nonpreventable complications and deaths.

RESULTS: The patient populations from the 2 time periods were clinically similar. No significant differences were found in the total and the preventable death rates. The time period after the 80-hour workweek mandate had a significantly higher total complication rate (5.64% vs 7.28%; relative risk, 1.29; 95% confidence interval, 1.15-1.45; P < .001), preventable complication rate (0.89% vs 1.28%; relative risk, 1.43; 95% confidence interval, 1.06-1.91; P = .02), and nonpreventable complication rate (4.75% vs 5.81%; relative risk, 1.22; 95% confidence interval, 1.08-1.39; P = .002).

CONCLUSION: Although there was no difference in deaths between the 2 time periods, there was a significant increase in total, preventable, and nonpreventable complications. This increase in complication rate may be due, in part, to the new 80-hour workweek policy.

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