The impact of resident work-hour restrictions on outcomes of cardiac operations

J Surg Res. 2009 Dec;157(2):268-74. doi: 10.1016/j.jss.2009.03.042. Epub 2009 May 3.


Background: The Accreditation Council of Graduate Medical Education mandated an 80-h/wk resident physician work-hour restriction on July 1, 2003. The objective of this study was to evaluate the impact of the resident work-hour restriction on outcomes of cardiac operations.

Materials and method: We reviewed records of 1562 patients who underwent cardiac operations at our institution between 1997 and 2007, and we compared outcomes of operations performed before July 1, 2003 (pre-reform, n=777) and those performed after July 1, 2003 (post-reform, n=785). Multivariate analysis with logistic regression was used to test for the independent effects of the resident work-hour reform by controlling for patient-specific confounding factors.

Results: Post-reform patients had a significantly lower 30-d mortality rate (1.8% versus 3.9%; P=0.01) and a slightly lower 6-month mortality rate (4.5% versus 6.3%; P=0.12) than pre-reform patients. Multivariate analysis revealed that the post-reform patients had significantly lower adjusted 30-d mortality (odds ratio, 0.37; 95% CI, 0.18-0.75; P=0.006) and 6-mo mortality (odds ratio, 0.56; 95% CI, 0.34-0.91; P=0.02) than the pre-reform patients.

Conclusions: Cardiac operations performed after the resident work-hour restriction went into effect were associated with significantly lower adjusted 30-d and 6-mo mortality rates than were operations performed before the work-hour restriction became effective.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Cardiac Surgical Procedures / mortality*
  • Education, Medical, Continuing
  • Female
  • Hospital Mortality / trends
  • Humans
  • Internship and Residency*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Retrospective Studies
  • Survival Rate
  • Texas / epidemiology
  • Work Schedule Tolerance / psychology*