Higher Complications and No Improvement in Mortality in the ACGME Resident Duty-Hour Restriction Era: An Analysis of over 107,000 Neurosurgical Trauma Patients in the Nationwide Inpatient Sample database

Keywords: trauma, database, complications, outcome, education

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     The ACGME resident duty-hour restrictions were implemented in July 2003 based on the supposition that resident fatigue contributes to medical errors.
     We examined the effect of duty-hour restrictions on outcome in neurotrauma patients.
     An analysis of the Nationwide Inpatient Sample database (NIS) was performed. A time period with no duty-hour restrictions (1999-2002) was compared with a period with restrictions (2005-2008) for: 1) mortality and 2) complications. We analyzed both teaching and non-teaching hospitals to account for potential differences due to non-duty-hour related factors.
     There were 107,006 teaching hospital admissions and 115,604 non-teaching hospital admissions for neurosurgical trauma. Multivariate logistic regression demonstrated, in teaching hospitals, significantly higher risk of complication in the time period with restrictions. In non-teaching hospitals, there was no difference in complication rate. In teaching hospitals, there was no significant difference in mortality rate between the two time periods. In non-teaching hospitals, there was a significant improvement in mortality in the time period with restrictions compared to no restrictions.
     This is a retrospective study of database.
     The implementation of the ACGME resident duty-hour restrictions was associated with increased complications and no change in mortality for neurotrauma patients in teaching hospitals. In non-teaching hospitals, there was no change in complications and an improvement in mortality.
     These findings could mean that the increase in complications seen in teaching hospitals was due to the implementation of resident duty-hour restrictions, and that the overall improvement in mortality seen in non-teaching hospitals was negated in teaching hospitals because of an increase in mortality due to resident duty-hour restrictions.


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