Impact of the 80-Hour Workweek on Patient Care at a Level I Trauma Center

Abstract

Hypothesis:The 80-hour workweek limitation for surgical residents is associated with an increase in mortality and complication rates among adult trauma surgical patients.Design: Retrospective cohort study.Setting: Academic level I trauma center.Patients: Trauma patients admitted before and after the 80-hour workweek limitation.Methods: We compared death and complication rates for adult trauma patients admitted during a 24-month period before (2001)(2002)(2003) and a 24-month period after (2004)(2005)(2006) implementation of the 80-hour workweek at our institution. Relative risk and its 95% confidence intervals were examined.Main Outcome Measures: Patient care outcomes included preventable and nonpreventable complications and deaths. Results:The patient populations from the 2 time periods were clinically similar. No significant differences were found in the total and the preventable death rates. The time period after the 80-hour workweek mandate had a significantly higher total complication rate (5.64% vs 7.28%; relative risk, 1.29; 95% confidence interval, 1.15-1.45; PϽ.001), preventable complication rate (0.89% vs 1.28%; relative risk, 1.43; 95% confidence interval, 1.06-1.91; P = .02), and nonpreventable complication rate (4.75% vs 5.81%; relative risk, 1.22; 95% confidence interval, 1.08-1.39; P=.002). Conclusion:Although there was no difference in deaths between the 2 time periods, there was a significant increase in total, preventable, and nonpreventable complications. This increase in complication rate may be due, in part, to the new 80-hour workweek policy.

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