Introduction: The effects of sleep deprivation on performance have been well-documented in the literature and have led to changes in resident duty hour regulation. New York State implemented stricter resident duty hours in 1989 after sleep-deprivation among residents was determined to have contributed to a patient’s death.
Methods: Using the Nationwide Inpatient Sample (NIS) from 2000-2002 and 2004-2006, patients undergoing neurosurgical procedures at hospitals with neurosurgery training programs were identified along with their comorbid conditions, any in hospital complications they suffered, any in hospital procedures they underwent, their discharge destination and in hospital mortality. Comparisons were made between in-hospital complications, in-hospital mortality and discharge destination in New York hospitals versus non-New York hospitals before and after the ACGME regulations were put into effect in 2003.
Results: Analysis of discharge destination demonstrated that 81.9% of patients in the NY group 2000-02 were discharged to home compared to 84.1% in the non-NY group 2000-02 (p = 0.1). In hospital mortality did not significantly differ (2.9% versus 3.0%, p=0.8). After the ACGME regulations were in place, analysis of discharge destination demonstrated that 81.6% of patients in the non-NY group 2004-06 were discharged to home compared to 78.0% in the NY group 2004-06 (p = 0.2). In hospital mortality was not significantly different (3.1% versus 3.4%, p=0.5). After the ACGME regulations were implemented, there was a decrease in patients discharged to home- 84.1% of patients in the 2000-02 group compared to 81.5% in the 2004-06 group (p = 0.01). In hospital mortality did not significantly change (3.0% versus 3.1%, p=0.8). In NY there was no significant change in patient outcomes with the implementation of the ACGME regulations- 81.9% of patients in the 2000-02 group were discharged to home compared to 78.0% in the 2004-06 group (p = 0.5). In hospital mortality did not significantly change (2.9% versus 3.4%, p=0.5).
Conclusions: Restriction of resident duty hours has not resulted in significant changes in outcomes among neurosurgical patients.
Patient Care: Better understanding of the effects of different resident work hour regulations and schedules on overall patient outcomes will hopefully inform future regulations on resident work hours and training in order to also improve patient care.
Learning Objectives: To determine if increased regulation of resident duty hours results in changes in patient outcomes.