Volume 128, Issue 12 pp. 2804-2810

Head and Neck

The Impact of Duty-Hour Restrictions on Complication Rates Following Major Head and Neck Procedures

Meghan M. Crippen MS,

Meghan M. Crippen MS

orcid.org/0000-0001-5531-2552

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Gregory L. Barinsky PharmD,

Gregory L. Barinsky PharmD

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Renuka K. Reddy MD,

Renuka K. Reddy MD

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Marcus L. Elias BA,

Marcus L. Elias BA

orcid.org/0000-0003-3281-1660

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Jean Anderson Eloy MD, FACS,

Jean Anderson Eloy MD, FACS

orcid.org/0000-0003-2893-7818

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Neurological Institute of New Jersey; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Soly Baredes MD, FACS,

Soly Baredes MD, FACS

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Richard Chan Woo Park MD, FACS,

Corresponding Author

Richard Chan Woo Park MD, FACS

[email protected]

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Send correspondence to Richard Chan Woo Park, MD, Assistant Professor, Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103. E-mail: [email protected]Search for more papers by this author

Meghan M. Crippen MS,

Meghan M. Crippen MS

orcid.org/0000-0001-5531-2552

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Gregory L. Barinsky PharmD,

Gregory L. Barinsky PharmD

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Renuka K. Reddy MD,

Renuka K. Reddy MD

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Marcus L. Elias BA,

Marcus L. Elias BA

orcid.org/0000-0003-3281-1660

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Jean Anderson Eloy MD, FACS,

Jean Anderson Eloy MD, FACS

orcid.org/0000-0003-2893-7818

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Neurological Institute of New Jersey; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Soly Baredes MD, FACS,

Soly Baredes MD, FACS

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

Search for more papers by this author

Richard Chan Woo Park MD, FACS,

Corresponding Author

Richard Chan Woo Park MD, FACS

[email protected]

Department of Otolaryngology–Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.

First published: 03 October 2018

https://doi.org/10.1002/lary.27338

Citations: 2

Presented as an oral presentation at the Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A., January 18, 2018.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

Share a link

Email
Wechat
Bluesky

Abstract

Objectives/Hypothesis

To assess the impact of resident duty-hour restrictions (DHR) in otolaryngology via comparison of postoperative outcomes between otolaryngology teaching hospitals (Oto-TH) and nonteaching hospitals (NTH) before and after complete implementation.

Study Design

Retrospective database review.

Methods

The Nationwide Inpatient Sample was queried for all major head and neck cases between 2000 and 2002 (n = 34,064) and 2008 and 2010 (n = 33,094). Cases were stratified into Oto-TH (n = 28,771) and NTH (n = 38,387) and assessed for procedure type, patient comorbidities, and complications. A subpopulation matched by procedure type was generated for direct comparison of complication rates using χ² and binary logistic regression analyses.

Results

In the years following DHR, total case volume and average case complexity increased at Oto-TH only. Using a case-matched subpopulation, regression analysis found Oto-TH status to be protective for medical complications both before (odds ratio [OR]: 0.60, P < .001) and after (OR: 0.76, P = .001) DHR. In contrast, Oto-TH cases had lower risk for surgical complications in 2000 to 2002 (OR: 0.77, P < .001) but not 2008 to 2010 (OR: 1.07, P = .275). When comparing time periods, the years following DHR were associated with a significant decrease in medical complications and mortality across hospital cohorts. For surgical complications, rates significantly improved at NTH only (OR: 0.82, P = .002), with no difference at Oto-TH (OR: 0.95, P = .450).

Conclusions

In the years following DHR, rates of medical complications, surgical complications, and mortality have significantly improved at NTH. At Oto-TH, there has been a lack of similar improvement in surgical complications, even after accounting for increasing case volume and complexity in more recent years. While the cause is likely multifactorial, DHR in otolaryngology residency may play a role.

Level of Evidence

4 Laryngoscope, 128:2804–2810, 2018

BIBLIOGRAPHY

1Jagannathan J, Vates GE, Pouratian N, et al. Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity: special topic. JNeurosurg 2009; 110: 820–827.
10.3171/2009.2.JNS081446
PubMed Web of Science® Google Scholar
2Fletcher KE, Reed DA, Arora VM. Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules. JGen Intern Med 2011; 26: 907–919.
Web of Science® Google Scholar
3Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014; 259: 1041.
10.1097/SLA.0000000000000595
PubMed Web of Science® Google Scholar
4Fairfax LM, Christmas AB, Green JM, Miles WS, Sing RF. Operative experience in the era of duty hour restrictions: is broad-based general surgery training coming to an end? Am Surg 2010; 76: 578–582.
PubMed Web of Science® Google Scholar
5Reiter ER, Wong DR. Impact of duty hour limits on resident training in otolaryngology. Laryngoscope 2005; 115: 773–779.
10.1097/01.MLG.0000157696.03159.24
PubMed Web of Science® Google Scholar
6Brunworth JD, Sindwani R. Impact of duty hour restrictions on otolaryngology training: divergent resident and faculty perspectives. Laryngoscope 2006; 116: 1127–1130.
10.1097/01.mlg.0000224348.44616.fb
PubMed Web of Science® Google Scholar
7Dumont TM, Tranmer BI, Horgan MA, Rughani AI. Trends in neurosurgical complication rates at teaching vs nonteaching hospitals following duty-hour restrictions. Neurosurgery 2012; 71: 1041–1046.
10.1227/NEU.0b013e31826cdd73
PubMed Web of Science® Google Scholar
8Browne JA, Cook C, Olson SA, Bolognesi MP. Resident duty-hour reform associated with increased morbidity following hip fracture. JBone Joint Surg Am 2009; 91: 2079–2085.
10.2106/JBJS.H.01240
PubMed Web of Science® Google Scholar
9Hoh BL, Neal DW, Kleinhenz DT, Hoh DJ, Mocco J, Barker FG. Higher complications and no improvement in mortality in the ACGME resident duty-hour restriction era: an analysis of more than 107 000 neurosurgical trauma patients in the nationwide inpatient sample database. Neurosurgery 2012; 70: 1369–1382.
10.1227/NEU.0b013e3182486a75
PubMed Web of Science® Google Scholar
10Gopaldas RR, Chu D, Dao TK, et al. Impact of ACGME work-hour restrictions on the outcomes of coronary artery bypass grafting in a cohort of 600,000 patients. JSurg Res 2010; 163: 201–209.
10.1016/j.jss.2010.03.014
PubMed Web of Science® Google Scholar
11Smith A, Jain N, Wan J, Wang L, Sebelik M. Duty hour restrictions and surgical complications for head and neck key indicator procedures. Laryngoscope 2017; 127: 1797–1803.
10.1002/lary.26464
PubMed Web of Science® Google Scholar
12Babu R, Thomas S, Hazzard MA, et al. Worse outcomes for patients undergoing brain tumor and cerebrovascular procedures following the ACGME resident duty-hour restrictions. JNeurosurg 2014; 121: 262–276.
10.3171/2014.5.JNS1314
PubMed Web of Science® Google Scholar
13Smith A, Braden L, Wan J, Sebelik M. Association of otolaryngology resident duty hour restrictions with procedure-specific outcomes in head and neck endocrine surgery. JAMA Otolaryngol Head Neck Surg 2017; 143: 549–554.
10.1001/jamaoto.2016.4182
PubMed Web of Science® Google Scholar
14Damadi A, Davis AT, Saxe A, Apelgren K. ACGME duty-hour restrictions decrease resident operative volume: a 5-year comparison at an ACGME-accredited university general surgery residency. JSurg Educ 2007; 64: 256–259.
10.1016/j.jsurg.2007.07.008
PubMed Google Scholar
15Curtis SH, Miller RH, Weng C, Gurgel RK. The effect of duty hour regulation on resident surgical case volume in otolaryngology. Otolaryngol Head Neck Surg 2014; 151: 599–605.
10.1177/0194599814546111
PubMed Web of Science® Google Scholar
16Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 2011; 364: 2128–2137.
10.1056/NEJMsa1010705
CAS PubMed Web of Science® Google Scholar
17Semel ME, Lipsitz SR, Funk LM, Bader AM, Weiser TG, Gawande AA. Rates and patterns of death after surgery in the United States, 1996 and 2006. Surgery 2012; 151: 171–182.
10.1016/j.surg.2011.07.021
PubMed Web of Science® Google Scholar
18Montroy J, Breau RH, Cnossen S, et al. Change in adverse events after enrollment in the National Surgical Quality Improvement Program: a systematic review and meta-analysis. PLoS One 2016; 11: e0146254.
10.1371/journal.pone.0146254
PubMed Web of Science® Google Scholar
19Stachler RJ, Yaremchuk K, Ritz J. Preliminary NSQIP results: a tool for quality improvement. Otolaryngol Head Neck Surg 2010; 143: 26–30.e23.
10.1016/j.otohns.2010.02.017
PubMed Web of Science® Google Scholar
20Brady JS, Crippen MM, Filimonov A, et al. The effect of training level on complications after free flap surgery of the head and neck. Am J Otolaryngol 2017; 38: 560–564.
10.1016/j.amjoto.2017.06.001
PubMed Web of Science® Google Scholar
21Meier JC, Remenschneider AK, Gray ST, Holbrook EH, Gliklich RE, Metson R. The impact of surgical trainee participation on sinus surgery outcomes. Laryngoscope 2016; 126: 316–321.
10.1002/lary.25504
PubMed Web of Science® Google Scholar
22Baker AB, Ong AA, O'Connell BP, Sokohl AD, Clinkscales WB, Meyer TA. Impact of resident involvement in outpatient otolaryngology procedures: an analysis of 17,647 cases. Laryngoscope 2017; 127: 2026–2032.
10.1002/lary.26645
PubMed Web of Science® Google Scholar

Citing Literature

Volume128, Issue12

December 2018

Pages 2804-2810

The Impact of Duty-Hour Restrictions on Complication Rates Following Major Head and Neck Procedures

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

The Impact of Duty-Hour Restrictions on Complication Rates Following Major Head and Neck Procedures

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusions

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

Information