外科住院在夜間開的刀，預後不會較差，80hr work hours的反撲
July 29, 2010 — Surgeries performed at night by unrested residents have outcomes comparable to those performed at the beginning of a shift, during the day, according to a new study.
Arezou Yaghoubian, MD, from the Department of Surgery, Harbor–University of California–Los Angeles Medical Center, Torrance, and colleagues reported the findings online July 26 in the Journal of Surgical Research.
According to background information in the article, the 80-hour workweek was adopted by all US surgical training programs in 2003. However "no data are available regarding outcomes of operations performed by surgical trainees working without rest beyond 16 h in the current 80-h workweek era," the authors note.
In addition to existing restrictions, the Institute of Medicine and the Accreditation Council for Graduate Medical Education have recommended further limiting the hours worked by medical residents by requiring a 5-hour rest period after a 16-hour shift, which may ultimately limit the amount of critical training that surgeons receive.
To investigate whether a rest period would improve outcomes, Dr. Yaghoubian and colleagues conducted a retrospective review of all laparoscopic cholecystectomies and appendectomies, 2 of the most common procedures, performed by surgery residents at a public teaching hospital from July 2003 through March 2009.
During the 7-year study period, outcomes of 2908 laparoscopic cholecystectomies and 1726 appendectomies conducted between 6 am and 10 pm were compared with those conducted between 10 pm and 6 am, after the residents had been working an all-day, 16-hour shift. Outcomes assessed included complication rates, bile duct injury, conversion to open operation, length of surgery, and mortality.
Overall morbidity and mortality rates were comparable for operations performed during the nighttime vs daytime, with no differences in outcomes between the 2 groups. On multivariable analysis, the predictors of negative outcomes for appendectomy included male sex, operative time, and the presence of perforation; for cholecystectomy, these predictors were older age, male sex, and length of operation — not daytime vs nighttime procedure for either operation.
"Although we recognize that laparoscopic appendectomy/cholecystectomy have overall low postoperative morbidity and mortality, they are one of the most common operations performed at night by residents," the authors note. "Instituting a 5-h rest period at night is unlikely to improve outcomes of these commonly performed operations," they conclude.
According to study author Christian de Virgilio, MD, from LA BioMed, a nonprofit independent biomedical research institute, by reducing the hours per day available for surgical training, residents would miss out on critical aspects of a patient's care. "It will also further increase the costs and length of time to train surgeons," he states in a written release.
The authors have disclosed no relevant financial relationships.
J Surgical Res. Published online July 26, 2010.
Arezou Yaghoubian, MD, from the Department of Surgery, Harbor–University of California–Los Angeles Medical Center, Torrance, and colleagues reported the findings online July 26 in the Journal of Surgical Research.
According to background information in the article, the 80-hour workweek was adopted by all US surgical training programs in 2003. However "no data are available regarding outcomes of operations performed by surgical trainees working without rest beyond 16 h in the current 80-h workweek era," the authors note.
In addition to existing restrictions, the Institute of Medicine and the Accreditation Council for Graduate Medical Education have recommended further limiting the hours worked by medical residents by requiring a 5-hour rest period after a 16-hour shift, which may ultimately limit the amount of critical training that surgeons receive.
To investigate whether a rest period would improve outcomes, Dr. Yaghoubian and colleagues conducted a retrospective review of all laparoscopic cholecystectomies and appendectomies, 2 of the most common procedures, performed by surgery residents at a public teaching hospital from July 2003 through March 2009.
During the 7-year study period, outcomes of 2908 laparoscopic cholecystectomies and 1726 appendectomies conducted between 6 am and 10 pm were compared with those conducted between 10 pm and 6 am, after the residents had been working an all-day, 16-hour shift. Outcomes assessed included complication rates, bile duct injury, conversion to open operation, length of surgery, and mortality.
Overall morbidity and mortality rates were comparable for operations performed during the nighttime vs daytime, with no differences in outcomes between the 2 groups. On multivariable analysis, the predictors of negative outcomes for appendectomy included male sex, operative time, and the presence of perforation; for cholecystectomy, these predictors were older age, male sex, and length of operation — not daytime vs nighttime procedure for either operation.
"Although we recognize that laparoscopic appendectomy/cholecystectomy have overall low postoperative morbidity and mortality, they are one of the most common operations performed at night by residents," the authors note. "Instituting a 5-h rest period at night is unlikely to improve outcomes of these commonly performed operations," they conclude.
According to study author Christian de Virgilio, MD, from LA BioMed, a nonprofit independent biomedical research institute, by reducing the hours per day available for surgical training, residents would miss out on critical aspects of a patient's care. "It will also further increase the costs and length of time to train surgeons," he states in a written release.
The authors have disclosed no relevant financial relationships.
J Surgical Res. Published online July 26, 2010.
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