Increased rate of complications on a neurological surgery service after implementation of the Accreditation Council for Graduate Medical Education work-hour restriction

Clinical article

Travis M Dumont, Anand I. Rughani, Paul L. Penar, Michael A. Horgan, Bruce I. Tranmer, Ryan P. Jewell

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Object. The Accreditation Council for Graduate Medical Education instituted mandatory 80-hour work-week limitations in July 2003. The work-hour restriction was met with skepticism among the academic neurosurgery community and is thought to represent a barrier to teaching, ultimately compromising patient care. The authors hypothesize that the introduction of the mandatory resident work-hour restriction corresponds with an overall increase in morbidity rate. Methods. This study compares the morbidity and mortality rates on an academic neurological surgery service before and after institution of the work-hour restriction. Complications are individually assessed at a monthly divisional conference by neurosurgical faculty and residents. A prospective database was commenced in July 2000 recording all complications, complications that were deemed to be potentially avoidable ("possibly preventable"), and complications that were deemed unavoidable. The incidence of morbidity and mortality from July 2000 to June 2003 is compared with the incidence from July 2003 to June 2006. Results. The overall rate of morbidity and mortality increased from 103 to 114 per 1000 patients treated after institution of the work-hour restriction, although this increase was not statistically significant (&χηι; 2 1, N = 8546 = 2.6, p = 0.106). The morbidity rate increased from 70 to 89 per 1000 patients treated after institution of the work-hour restriction (&χηι; 2 1, N = 8546 = 10, p = 0.001). The overall mortality rate was diminished from 32 to 27 per 1000 patients treated after institution of the work-hour restriction (&χηι; 2 1, N = 8546 = 3.2, p = 0.075). Morbidities considered avoidable or possibly preventable were seen to increase from 56 to 66 per 1000 patients treated (&χηι ; 2 1, N = 8546 = 5.7, p = 0.017). Avoidable or possibly preventable mortalities numbered 3 per 1000 patients treated, and this rate did not change after introduction of the work-hour restriction (&χη ι; 2 1, N = 8546 = 0.08, p = 0.777). Conclusions. The morbidity rate on a neurological surgery service is increased after implementation of the workhour restriction. Mortality rates remain unchanged.

Original languageEnglish (US)
Pages (from-to)483-486
Number of pages4
JournalJournal of Neurosurgery
Volume116
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Graduate Medical Education
Accreditation
Morbidity
Mortality
Incidence
Neurosurgery
Patient Care
Teaching
Databases

Keywords

  • Accreditation Council for Graduate Medical Education
  • Complications
  • Neurosurgery
  • Work-hour restriction

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Increased rate of complications on a neurological surgery service after implementation of the Accreditation Council for Graduate Medical Education work-hour restriction : Clinical article. / Dumont, Travis M; Rughani, Anand I.; Penar, Paul L.; Horgan, Michael A.; Tranmer, Bruce I.; Jewell, Ryan P.

In: Journal of Neurosurgery, Vol. 116, No. 3, 03.2012, p. 483-486.

Research output: Contribution to journalArticle

@article{e6cc548156be4442a56ecd79afb81bfa,
title = "Increased rate of complications on a neurological surgery service after implementation of the Accreditation Council for Graduate Medical Education work-hour restriction: Clinical article",
abstract = "Object. The Accreditation Council for Graduate Medical Education instituted mandatory 80-hour work-week limitations in July 2003. The work-hour restriction was met with skepticism among the academic neurosurgery community and is thought to represent a barrier to teaching, ultimately compromising patient care. The authors hypothesize that the introduction of the mandatory resident work-hour restriction corresponds with an overall increase in morbidity rate. Methods. This study compares the morbidity and mortality rates on an academic neurological surgery service before and after institution of the work-hour restriction. Complications are individually assessed at a monthly divisional conference by neurosurgical faculty and residents. A prospective database was commenced in July 2000 recording all complications, complications that were deemed to be potentially avoidable ({"}possibly preventable{"}), and complications that were deemed unavoidable. The incidence of morbidity and mortality from July 2000 to June 2003 is compared with the incidence from July 2003 to June 2006. Results. The overall rate of morbidity and mortality increased from 103 to 114 per 1000 patients treated after institution of the work-hour restriction, although this increase was not statistically significant (&χηι; 2 1, N = 8546 = 2.6, p = 0.106). The morbidity rate increased from 70 to 89 per 1000 patients treated after institution of the work-hour restriction (&χηι; 2 1, N = 8546 = 10, p = 0.001). The overall mortality rate was diminished from 32 to 27 per 1000 patients treated after institution of the work-hour restriction (&χηι; 2 1, N = 8546 = 3.2, p = 0.075). Morbidities considered avoidable or possibly preventable were seen to increase from 56 to 66 per 1000 patients treated (&χηι ; 2 1, N = 8546 = 5.7, p = 0.017). Avoidable or possibly preventable mortalities numbered 3 per 1000 patients treated, and this rate did not change after introduction of the work-hour restriction (&χη ι; 2 1, N = 8546 = 0.08, p = 0.777). Conclusions. The morbidity rate on a neurological surgery service is increased after implementation of the workhour restriction. Mortality rates remain unchanged.",
keywords = "Accreditation Council for Graduate Medical Education, Complications, Neurosurgery, Work-hour restriction",
author = "Dumont, {Travis M} and Rughani, {Anand I.} and Penar, {Paul L.} and Horgan, {Michael A.} and Tranmer, {Bruce I.} and Jewell, {Ryan P.}",
year = "2012",
month = "3",
doi = "10.3171/2011.9.JNS116",
language = "English (US)",
volume = "116",
pages = "483--486",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "3",

}

TY - JOUR

T1 - Increased rate of complications on a neurological surgery service after implementation of the Accreditation Council for Graduate Medical Education work-hour restriction

T2 - Clinical article

AU - Dumont, Travis M

AU - Rughani, Anand I.

AU - Penar, Paul L.

AU - Horgan, Michael A.

AU - Tranmer, Bruce I.

AU - Jewell, Ryan P.

PY - 2012/3

Y1 - 2012/3

N2 - Object. The Accreditation Council for Graduate Medical Education instituted mandatory 80-hour work-week limitations in July 2003. The work-hour restriction was met with skepticism among the academic neurosurgery community and is thought to represent a barrier to teaching, ultimately compromising patient care. The authors hypothesize that the introduction of the mandatory resident work-hour restriction corresponds with an overall increase in morbidity rate. Methods. This study compares the morbidity and mortality rates on an academic neurological surgery service before and after institution of the work-hour restriction. Complications are individually assessed at a monthly divisional conference by neurosurgical faculty and residents. A prospective database was commenced in July 2000 recording all complications, complications that were deemed to be potentially avoidable ("possibly preventable"), and complications that were deemed unavoidable. The incidence of morbidity and mortality from July 2000 to June 2003 is compared with the incidence from July 2003 to June 2006. Results. The overall rate of morbidity and mortality increased from 103 to 114 per 1000 patients treated after institution of the work-hour restriction, although this increase was not statistically significant (&χηι; 2 1, N = 8546 = 2.6, p = 0.106). The morbidity rate increased from 70 to 89 per 1000 patients treated after institution of the work-hour restriction (&χηι; 2 1, N = 8546 = 10, p = 0.001). The overall mortality rate was diminished from 32 to 27 per 1000 patients treated after institution of the work-hour restriction (&χηι; 2 1, N = 8546 = 3.2, p = 0.075). Morbidities considered avoidable or possibly preventable were seen to increase from 56 to 66 per 1000 patients treated (&χηι ; 2 1, N = 8546 = 5.7, p = 0.017). Avoidable or possibly preventable mortalities numbered 3 per 1000 patients treated, and this rate did not change after introduction of the work-hour restriction (&χη ι; 2 1, N = 8546 = 0.08, p = 0.777). Conclusions. The morbidity rate on a neurological surgery service is increased after implementation of the workhour restriction. Mortality rates remain unchanged.

AB - Object. The Accreditation Council for Graduate Medical Education instituted mandatory 80-hour work-week limitations in July 2003. The work-hour restriction was met with skepticism among the academic neurosurgery community and is thought to represent a barrier to teaching, ultimately compromising patient care. The authors hypothesize that the introduction of the mandatory resident work-hour restriction corresponds with an overall increase in morbidity rate. Methods. This study compares the morbidity and mortality rates on an academic neurological surgery service before and after institution of the work-hour restriction. Complications are individually assessed at a monthly divisional conference by neurosurgical faculty and residents. A prospective database was commenced in July 2000 recording all complications, complications that were deemed to be potentially avoidable ("possibly preventable"), and complications that were deemed unavoidable. The incidence of morbidity and mortality from July 2000 to June 2003 is compared with the incidence from July 2003 to June 2006. Results. The overall rate of morbidity and mortality increased from 103 to 114 per 1000 patients treated after institution of the work-hour restriction, although this increase was not statistically significant (&χηι; 2 1, N = 8546 = 2.6, p = 0.106). The morbidity rate increased from 70 to 89 per 1000 patients treated after institution of the work-hour restriction (&χηι; 2 1, N = 8546 = 10, p = 0.001). The overall mortality rate was diminished from 32 to 27 per 1000 patients treated after institution of the work-hour restriction (&χηι; 2 1, N = 8546 = 3.2, p = 0.075). Morbidities considered avoidable or possibly preventable were seen to increase from 56 to 66 per 1000 patients treated (&χηι ; 2 1, N = 8546 = 5.7, p = 0.017). Avoidable or possibly preventable mortalities numbered 3 per 1000 patients treated, and this rate did not change after introduction of the work-hour restriction (&χη ι; 2 1, N = 8546 = 0.08, p = 0.777). Conclusions. The morbidity rate on a neurological surgery service is increased after implementation of the workhour restriction. Mortality rates remain unchanged.

KW - Accreditation Council for Graduate Medical Education

KW - Complications

KW - Neurosurgery

KW - Work-hour restriction

UR - http://www.scopus.com/inward/record.url?scp=84857802894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857802894&partnerID=8YFLogxK

U2 - 10.3171/2011.9.JNS116

DO - 10.3171/2011.9.JNS116

M3 - Article

VL - 116

SP - 483

EP - 486

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 3

ER -