Impact of the 80-hour workweek on surgical case exposure within a general surgery residency program

Objective: The objective of this statistical analysis was to test the hypothesis that implementation of the 80-hour workweek restrictions for General Surgery residents at Riverside Methodist Hospital after July 2003 decreased their operative experience relative to surgical residents trained at Riverside before these changes.

Design, setting, participants: Data were collected from the Accreditation Council for Graduate Medical Education national database and from Riverside Methodist Hospital's General Surgery Residency records for a sampling of academic years before and after the duty-hour changes in surgical education (July 1, 2003). Current procedural terminology (CPT) surgical procedure codes logged by postgraduate year (PGY) 5 General Surgery residents 15 years before and 5 years after implementation of the 80-hour workweek were compared. The outcome variables "total major cases" and "Chief cases" were compared between 2 study groups defined by the time intervals exclusively before July 2003 ("pre") and inclusively after July 2003 ("post"). Hospital general surgical case volume for the study intervals was also tallied. Statistical analyses included 1- and 2-sided t-tests, nonparametric tests, and t-tests on a 3-parameter logarithmic transformation of the data.

Results: Despite an upward trend in total general surgery cases (slope = 25/year, p = 0.005), there was a statistically significant decrease in the operative experience for categorical surgical residents following the 80-hour workweek restrictions. The mean (SD) number of major cases performed by "pre"-restriction residents during their training significantly exceeded that of their "post" cohorts (1395 [326] vs 953 [134], p < 0.001). The training for PGY 5 residents was similarly influenced (345 [81] vs 237 [55], p < .0001).

Conclusions: Despite an increase in the total number of major operative cases available, the volume of cases performed by residents has decreased after implementation of the Accreditation Council for Graduate Medical Education (ACGME) work-hour restrictions. Our data suggest that the impact of the 80-hour workweek has had a detrimental effect on the conventional resident training experience.