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ACS NSQIP Data: Work hour reform does not improve surgical safety



Work hour restrictions for resident physicians, revised nationally four years ago largely to protect patients against trainees’ fatigue-related errors, have failed to have the desired effect of lowering postoperative complication rates in several common surgical specialties, according to new study results. The study was published as an “article in press,” available at, on the Journal of the American College of Surgeons website in advance of print publication later this year. Patient outcomes data for the study were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®). There was no significant difference in measured surgical patient outcomes between one year before and two years after the 2011 resident duty hour reform was implemented by the Accreditation Council for Graduate Medical Education (ACGME), according to the study authors. The ACGME is the accrediting and standards-setting body for approximately 9,500 U.S. medical residency programs.

The investigators evaluated outcomes within 30 days of an operation—a combined measure of patients’ deaths and serious complications—in five surgical specialties: neurosurgery, obstetrics/gynecology, orthopaedic surgery, urology, and vascular surgery.

“This study adds to the body of medical literature showing no strong association between resident duty-hour reform and change in postoperative outcomes,” said lead investigator Ravi Rajaram, MD, MSc, a Clinical Scholar in Residence at the ACS and a fellow with the Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, IL. Coauthor Clifford Y. Ko, MD, MS, MSHS, FACS, Director of ACS NSQIP and the ACS Division of Research and Optimal Patient Care, said the study shows that patient outcomes were not worse with less restrictive resident duty hours, likely because there was greater continuity of care than under the current policy.

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