This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Academic Medical Centers  • Law and Medicine  • Medical Education  • Patient Safety/ Medical Error  • Prognosis/ Outcomes  • Hepatobiliary Surgery  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Arezou Yaghoubian, MD; Guy Saltmarsh, MD; David K. Rosing, MD; Roger J. Lewis, MD, PhD; Bruce E. Stabile, MD; Christian de Virgilio, MD

Arch Surg. 2008;143(9):847-851.

Background  Considerable concern has been raised about the effects of restricted duty hours on surgical training. However, to our knowledge, the effect of the 80-hour resident workweek on operative outcomes after laparoscopic cholecystectomy has not been well studied.

Objective  To compare the rates of bile duct injury and overall complications after laparoscopic cholecystectomy before and after the institution of the duty-hour restriction.

Design  Retrospective review of patient medical records to determine morbidity and mortality before (January 1, 2000, to June 30, 2003; period 1) and after (July 1, 2003, to June 30, 2006; period 2) implementation of duty hour limitations.

Setting  Major public teaching hospital.

Patients  A total of 2470 patients who had undergone laparoscopic cholecystectomy.

Main Outcome Measures  Bile duct injury and overall complication rates as determined using multivariate analysis.

Results  Overall, 2470 laparoscopic cholecystectomy procedures were performed, including 1353 in period 1 and 1117 in period 2. In period 2, more patients had acute cholecystitis as the indication for surgery (49% vs 35% in period 1, P < .001), and a higher percentage of patients were male (22% vs 18%, P = .01). The incidence of bile duct injury and total complications decreased in period 2 from 1% to 0.4%(P = .04) and from 5% to 2% (P < .001), respectively. Mortality was unchanged. Multivariate analysis revealed that period 2 was protective for bile duct injury (odds ratio, 0.31; 95% confidence interval, 0.1-0.96; P = .04). For complications, both female sex (odds ratio, 0.62; 95% confidence interval, 0.38-0.9) and surgery during period 2 (odds ratio, 0.46; 95% confidence interval, 0.28-0.75) were protective, whereas older age (odds ratio, 1.03; 95% confidence interval, 1.02-1.05) was associated with complications.

Conclusion  At a major public teaching hospital, the bile duct injury rate and the overall complication rate decreased after implementation of the 80-hour workweek.

Author Affiliations: Departments of Surgery (Drs Yaghoubian, Saltmarsh, Rosing, Stabile, and de Virgilio) and Emergency Medicine (Dr Lewis) and Los Angeles Biomedical Research Institute (Drs Lewis, Stabile, and de Virgilio), Harbor-UCLA Medical Center, Torrance, California.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?