Decreased Bile Duct Injury Rate During Laparoscopic Cholecystectomy in the Era of the 80-Hour Resident Workweek
Yaghoubian A, Saltmarsh G, Rosing DK, et al.
Arch Surg. 2008;143:847-851
Summary
This study compared the rates of bile duct injuries after laparoscopic cholecystectomy before and after implementation of the restriction of surgical residents' working hours. The authors reviewed 2470 procedures:1353 were performed before the 80-hour work week limit and 1117 after the restriction of work hours. When the "before" and "after" periods were compared, bile duct injuries had decreased from 1% to 0.4% (15 vs 4).A multivariate analysis revealed that the reduction in injury rate was highly significant, with the reduced working hours acting as a protective factor (P = .002).
Viewpoint
The authors concluded that the restriction of residents' working hours was associated with a lower bile duct injury rate. However, the frequency of major bile duct injuries (2 vs 3) remained the same, and only minor problems, such as bile duct leakage, decreased. Because many other factors may have changed during the two time periods, assuming causality may be incorrect. A randomized trial is impossible, so the true effect of a change in working hours remains unknown.
Abstract