de Virgilio Christian, Yaghoubian Arezou, Lewis Roger J, Stabile Bruce E, Putnam Brant A
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
Curr Surg. 2006 Nov-Dec;63(6):435-9; discussion 440. doi: 10.1016/j.cursur.2006.03.006.
To determine whether the 80-hour resident workweek adversely affects patient outcomes or resident education.
To assess patient outcomes, the authors reviewed trauma patient morbidity and mortality at the second busiest level I trauma center in Los Angeles County before (July 1998-June 2003, Period 1) and after (July 2003-June 2005, Period 2) implementation of the duty hour limitation via a retrospective review of a prospective database. All patients were operated and managed by residents under faculty supervision. Patient characteristics included the injury severity score (ISS), mechanism of injury, complications, and death. To assess resident education, the authors compared ABSITE percentile scores, first-time pass rates on the American Board of Surgery Qualifying and Certifying Examinations, and total and chief resident operative case volumes. In addition, they estimated institutional costs incurred to comply with the new duty hour rules.
Patient outcomes. Over the entire 7-year study period, 11,518 trauma patients were transported to Harbor-UCLA Medical Center. Compared with Period 1, Period 2 experienced an increase in average yearly patient volume from 1510 to 1981 (p 0.01). The average ISS also increased, from 7.9 to 9.6 (p < 0.0001), as did the proportion of penetrating trauma from 14.8% to 17.6% (p < 0.0001). Morbidity and mortality rates remained unchanged. Resident education. Mean ABSITE scores and first-time Qualifying and Certifying Exam pass rates were unchanged. Mean resident total major case volumes increased significantly in Period 2 from 831 to 1156 (p < 0.0001), whereas chief resident year case volumes were unchanged. The estimated cost incurred by this institution to conform to the new work hour standards was approximately 359,000 dollars per year.
Despite concerns that the 80-hour workweek might threaten patient care and resident education, the morbidity and mortality rates at a busy level I trauma center remained unchanged. The quality of surgical resident education, as measured by operative volumes, ABSITE scores, and written and oral board examination pass rates were likewise unchanged. The reorganization of the authors' general surgery residency program to comply with the duty hour restrictions was achieved within reasonable cost.
确定住院医师每周80小时的工作时长是否会对患者治疗结果或住院医师教育产生不利影响。
为评估患者治疗结果，作者通过回顾前瞻性数据库，对洛杉矶县第二繁忙的一级创伤中心在实施工作时长限制之前（1998年7月至2003年6月，第1阶段）和之后（2003年7月至2005年6月，第2阶段）的创伤患者发病率和死亡率进行了回顾。所有患者均由住院医师在教员监督下进行手术和管理。患者特征包括损伤严重程度评分（ISS）、损伤机制、并发症和死亡情况。为评估住院医师教育情况，作者比较了美国外科医师资格考试（ABSITE）百分位分数、美国外科委员会资格考试和认证考试的首次通过率，以及住院总医师和主治住院医师的手术病例数量。此外，他们还估算了机构为遵守新的工作时长规定而产生的成本。
患者治疗结果。在整个7年的研究期间，11518名创伤患者被送往哈伯-加州大学洛杉矶分校医学中心。与第1阶段相比，第2阶段的年平均患者数量从1510例增加到1981例（p<0.01）。平均ISS也有所增加，从7.9提高到9.6（p<0.0001），穿透性创伤的比例也从14.8%增至17.6%（p<0.0001）。发病率和死亡率保持不变。住院医师教育。ABSITE平均分数以及资格考试和认证考试的首次通过率均未改变。第2阶段住院医师的平均总主要病例数量从831例显著增加到1156例（p<0.0001），而主治住院医师的年度病例数量未变。该机构为符合新的工作时长标准而产生的估计成本约为每年359,000美元。
尽管有人担心每周80小时的工作时长可能会威胁患者护理和住院医师教育，但繁忙的一级创伤中心的发病率和死亡率保持不变。通过手术量、ABSITE分数以及笔试和口试通过率衡量的外科住院医师教育质量同样未变。作者的普通外科住院医师培训计划为遵守工作时长限制进行的重组在合理成本范围内得以实现。
