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Trauma Surgery Performed by “Sleep Deprived” Residents: Are Outcomes Affected?

Trauma Surgery Performed by “Sleep Deprived” Residents: Are Outcomes Affected?. Arezou Yaghoubian MD, Amy H. Kaji MD PhD, Brant Putnam MD and Christian de Virgilio MD. Surgical Outcomes Pre and Post Duty Hours. 1 study: decreased rate of bile duct injury

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Trauma Surgery Performed by “Sleep Deprived” Residents: Are Outcomes Affected?

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  1. Trauma Surgery Performed by “Sleep Deprived” Residents: Are Outcomes Affected? Arezou Yaghoubian MD,Amy H. Kaji MD PhD, Brant Putnam MD and Christian de Virgilio MD

  2. Surgical Outcomes Pre and Post Duty Hours • 1 study: decreased rate of bile duct injury • 10 studies: no change in surgical patient outcome • 4 studies: worse patient outcomes

  3. Trauma Surgery Outcomes: Before and After 80-hr Workweek • de Virgilio et al • Mortality and morbidity unchanged • Salim et al • Mortality unchanged • Increase in the complication rate • Morrison et al • National Trauma Data Bank • Slightly decreased mortality (4.5% vs. 4.6%)

  4. New IOM Recommendations CALL No more than Q 3rd Night 5 hr nap time > 16 hours of work during a 30-hour shift Max 16 hr shift without protected sleep DAYS OFF 5 days/month TIME OFF BETWEEN SHIFTS 10 hours off between day shifts 12 hours off after night shift 14 hours off after 30 hr shift

  5. Implications of New IOM Recommendations • Effects on surgical training • Eliminates 24 hr+ call • De facto duty hour reduction from 8056 hr/wk • Increase length of surgical residency • The European experience • 58 hours/week • Decreased patient interaction • Loss of continuity of care • Detrimental effect on operative volume

  6. Purpose of Study To compare outcomes of trauma surgery performed by surgical residents during 1st 16 hours of shift vs. those performed by residents beyond 16 hr shift

  7. Methods • Retrospective review • All urgent/emergent trauma surgery since duty hour restriction (July 2003-2009) • Comparison of two time periods: • 6 am-10 pm (daytime) vs. 10 pm- 6 am (nighttime) • Operations after 10 pm performed by residents who began their shift at 6 am and had thus been working 16>hours

  8. Outcomes Measures • Morbidity • Wound infection, pneumonia, DVT, pulmonary embolism and pulmonary insufficiency • Mortality

  9. Why Harbor-UCLA an Ideal Setting for the Study? • Urban busy Level I trauma center • High volume penetrating injuries • No night float system • Residents on the Trauma Service take call Q 3rd night and work 24-hr shifts

  10. Results (n=1432)Comparison of Daytime vs.Nightime Operative Traumas

  11. Outcome Measures

  12. Multivariable Analysis-Morbidity

  13. Multivariable Analysis-Mortality

  14. Prior Studies on Daytime vs Nighttime General Surgery • Appendectomy • 878 daytime, 708 night time (>16 hr shift) • No difference in morbidity, mortality, conversion to open, or length of surgery • Cholecystectomy • 2522 daytime, 306 night time (>16 hr shift) • No difference in bile duct injury, overall morbidity, mortality, conversion to open, or length of surgery

  15. Conclusions • Trauma surgery performed at night by residents working >16 hrs have similar favorable outcomes as those performed by more rested residents • Instituting a 5-hour rest period after 16 hrs is unlikely to improve outcomes • When combined with our prior study (appendectomy and cholecystectomy), data even more compelling

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