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Has Restricting Resident Work Hours Detracted From Resident Operative Experience?
R. C. Connors1, J. R. Doty*2, D. A. Bull*1, H. T. May2, D. A. Fullerton*3, R. C. Robbins*4. 1University of Utah, Salt Lake City, UT, 2Intermountain Medical Center, Salt Lake City, UT, 3University of Colorado, Aurora, CO, 4Stanford University, Stanford, CA,
Background: Resident work hour regulations were instituted to improve patient care during resident training. While initial data has not shown the intended benefit of limiting resident work hours, concern has developed as to whether resident operative experience has significantly decreased since instituting the work hour restrictions.
Methods: Resident operative logs were reviewed for three training institutions in the western United States for residents graduating in the years 1999-2007. Residents were divided into pre-work hour restriction (1999-2002) and post-work hour restriction groups (2003-2007). Thoracic, cardiac and all combined cases were reviewed separately for all residents at yearly intervals. Statistical analysis was subsequently conducted.
Results: A total of 37 residents were identified from three different programs over the study period. Thoracic cases during the first, second and third year of residency were not affected by the work hour restrictions (Table 1). Cardiac cases were, however, significantly affected during each year of training (Table 2). The total number of cases was significantly lower during the first year, however the last 2 years were not significantly different (Table 3). And finally, all thoracic cases combined for all years showed no difference, however all cardiac cases and the total number of combined cases were significantly lower following the implementation of the 80-hour work week restriction (Table4).| TABLE 1 | Pre-restriction | Post-restriction | p-value | | Thoracic Year 1 | 106.7 | 117.2 | 0.93 | | Thoracic Year 2 | 61.5 | 62.1 | 0.55 | | Thoracic Year 3 | 11.0 | 29.9 | 0.22 |
| TABLE 2 | Pre-restriction | Post-restriction | p-value | | Cardiac Year 1 | 126.7 | 87.2 | 0.003 | | Cardiac Year 2 | 151.0 | 121.9 | 0.04 | | Cardiac Year 3 | 122.4 | 116.7 | 0.01 |
| TABLE 3 | Pre-restriction | Post-restriction | p-value | | Total cases Year 1 | 233.4 | 204.4 | 0.02 | | Total cases Year 2 | 212.5 | 190.9 | 0.38 | | Total cases Year 3 | 133.4 | 116.7 | 0.55 |
| TABLE 4 | Pre-restriction | Post-restriction | p-value | | All years Thoracic | 179.2 | 209.2 | 0.33 | | All years Cardiac | 400.1 | 325.8 | 0.0001 | | All years Total | 579.3 | 535.1 | 0.05 |
Conclusions: The overall volume of thoracic surgery cases was not significantly different following the implementation of the 80-hour work week restriction. The total number of cardiac cases logged was significantly lower during the same time period and therefore, as a result, the total number of cases performed following the implementation of the work hour restrictions was likewise significantly lower. While recent data has not shown an improvement in patient outcomes following restriction of resident work hours, we speculate that in a time of increasingly complex cases, reduction in resident operative experience due to work hour restrictions and declining cardiac cases may lead to inadequately trained residents.
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