Evaluating The Impact Of Acgme Resident Duty-Hour Restrictions On Outcomes For Bilateral Breast Reductions
David Chi, MD PhD, Austin D. Chen, MD, Winona W. Wu, MD, Anmol Chattha, MD, Bernard T. Lee, MD MBA MPH, Samuel J. Lin, MD MBA.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
PURPOSE: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented new resident duty-hour restrictions throughout the United States with the purpose of improving resident and patient well-being. While numerous studies have examined the effects of these restrictions on a variety of patient outcomes, results have been largely inconclusive; in addition, no efforts have been made to examine the impact of this reform on the safety of common plastic surgery procedures. In this study, we sought to assess the influence of ACGME duty-hour restrictions on outcomes for bilateral breast reductions.
METHODS: Bilateral breast reductions performed pre-reform (1998-2002) and post-reform (2004-2008) by non-New York teaching hospitals were gathered from the National Inpatient Sample (NIS) database. Multivariable logistic regression models were constructed to investigate the association between ACGME duty hour restrictions on surgical site, procedural, and medical complications (odds ratios, with 95% confidence intervals). Length of stay (LOS) was also assessed.
RESULTS: Overall, 40,948 bilateral breast reductions were identified. Breast reduction cases performed after the implementation of ACGME duty-hour restrictions (n=14,747) experienced increased procedural (OR=1.50, 1.17-1.91) and medical (OR=1.76,1.08-2.870) complications when compared with those performed prior to the reform (n=26,201). No significant differences were observed in surgical site complications (OR=1.48, 95% CI=0.84-2.61) or LOS between breast reductions performed pre- and post-reform.
CONCLUSIONS: ACGME duty-hour restrictions do not appear to be associated with better outcomes for bilateral breast reductions. Procedures performed post-reform observed significantly higher rates of procedural and medical complications, and experienced no differences in surgical site complications or LOS.
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