Impact of the 80-hour work week on mortality and morbidity in trauma patients: an analysis of the National Trauma Data Bank.

INTRODUCTION: The implementation of the 80-h work week restrictions implemented by the Accreditation Council for Graduate Medical Education (ACGME) in July 2003 were intended, in part, to improve patient outcomes by reducing fatigue-related resident errors. Although concerns were raised regarding the possibility for increased error due to decreased continuity of patient care, recent studies have shown no significant change in mortality or complication rates since the onset of these new restrictions. This study is the first to examine the effects of the 80-h work week on mortality in trauma patients on a national level.

METHODS: Data were obtained from the National Trauma Data Bank (NTDB) version 6.2 from 1994 to 2005. Data were then divided into two groups: "pre-80-h work week" (2001-2002) and "post-80-h work week" (2004-2005). Because the ACGME's guidelines were implemented mid-year in 2003, and because the NTDB classifies admission date only by year, all patients admitted during 2003 were excluded from the analysis. Information regarding patient demographics and hospital type (teaching versus nonteaching) was collected. Our primary outcome measure was mortality. Secondary outcomes included length of mechanical ventilation, length of ICU stay, and length of hospitalization.

RESULTS: The overall mortality rate decreased from 4.64% in the pre-80-h work week to 4.46% in the post-80-h work week (P < 0.0001). Of particular interest were the differences in outcomes observed in academic versus nonacademic institutions. In university hospitals, the mortality decreased from 5.16% to 5.03% (P = 0.03), whereas in nonteaching hospitals, mortality increased from 3.37% to 3.85% (P < 0.001). There were also small but statistically significant improvements seen in secondary outcomes during the post-80-h work week.

DISCUSSION: Despite the great deal of controversy surrounding the 80-h work week, few papers exist that specifically examine patient mortality within the field of trauma surgery. This large retrospective analysis demonstrates slightly decreased mortality and morbidity among trauma patients in university hospitals nationwide after implementation of the 80-h work week, even when controlling for possible confounders. Although these differences are not likely to be clinically important, the data are statistically very significant. Therefore, we conclude that the 80-h work week has not resulted in any significant deterioration in patient outcomes in this particular population.