Duty hour restrictions and surgical complications for head and neck key indicator procedures

Smith, Aaron; Jain, Nikhita; Wan, Jim Y.; Wang, Lei; Sebelik, Merry

doi:10.1002/lary.26464

Cited by 9 publications

(12 citation statements)

References 26 publications

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“…It is important to note, however, that changes in resident duty hours may not have the same consequences across surgical fields due to differences in average case acuity, case diversity, and operative time. Currently, two otolaryngology‐specific studies have utilized the NIS database to compare outcomes before and after duty‐hour restrictions, finding no significant difference in morbidity between time periods . However, these studies have been largely limited to select key‐indicator procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, two otolaryngology-specific studies have utilized the NIS database to compare outcomes before and after duty-hour restrictions, finding no significant difference in morbidity between time periods. 11,13 However, these studies have been largely limited to select key-indicator procedures. This is of concern because there is evidence to suggest that residents' operative experience has decreased in scope in the years following implementation of the 80-hour workweek.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the NIS provides hospital identifiers, allowing for a comparison of outcomes between teaching and nonteaching institutions. One NIS study specific to otolaryngology has been performed, finding no change in complication rates following key‐indicator cases before and after duty‐hour restrictions . However, in assessing only key‐indicator cases, this analysis may have obscured an increase in complications associated with less frequently performed procedures.…”

Section: Introductionmentioning

confidence: 99%

“…The Nationwide Inpatient Sample (NIS) database has been previously used for this type of analysis as a source of robust, population-based outcomes data. [7][8][9][10][11] Furthermore, the NIS provides hospital identifiers, allowing for a comparison of outcomes between teaching and nonteaching institutions. One NIS study specific to otolaryngology has been performed, finding no change in complication rates following key-indicator cases before and after duty-hour restrictions.…”

Section: Introductionmentioning

confidence: 99%

“…One NIS study specific to otolaryngology has been performed, finding no change in complication rates following key-indicator cases before and after duty-hour restrictions. 11 However, in assessing only key-indicator cases, this analysis may have obscured an increase in complications associated with less frequently performed procedures. Therefore, we sought to further explore the impact of duty-hour restrictions on patient outcomes using the NIS to examine complication rates following all major head and neck procedures.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%