The Impact of Resident Work-Hour Restrictions on Outcomes of Cardiac Operations

Abstract

The Accreditation Council of Graduate Medical Education mandated an 80-h/wk resident physician work-hour restriction on July 1, 2003. The objective of this study was to evaluate the impact of the resident work-hour restriction on outcomes of cardiac operations. We reviewed records of 1562 patients who underwent cardiac operations at our institution between 1997 and 2007, and we compared outcomes of operations performed before July 1, 2003 (pre-reform, n=777) and those performed after July 1, 2003 (post-reform, n=785). Multivariate analysis with logistic regression was used to test for the independent effects of the resident work-hour reform by controlling for patient-specific confounding factors. Post-reform patients had a significantly lower 30-d mortality rate (1.8% versus 3.9%; P=0.01) and a slightly lower 6-month mortality rate (4.5% versus 6.3%; P=0.12) than pre-reform patients. Multivariate analysis revealed that the post-reform patients had significantly lower adjusted 30-d mortality (odds ratio, 0.37; 95% CI, 0.18-0.75; P=0.006) and 6-mo mortality (odds ratio, 0.56; 95% CI, 0.34-0.91; P=0.02) than the pre-reform patients. Cardiac operations performed after the resident work-hour restriction went into effect were associated with significantly lower adjusted 30-d and 6-mo mortality rates than were operations performed before the work-hour restriction became effective.