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Lap Choly and the 80h Workweek

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Ever since surgical resident workweeks started getting shaved (it’s now 80 hours), there has been debate about how the change impacts quality in teaching hospitals. Proponents of the shorter workweek believe less fatigued residents make less errors. Skeptics fear that frequent shift changes increase the risk of errors in information transfer.

To date, studies of the matter have failed to silence the debate one way or the other.

The same can be said of the latest study [2] of laporoscopic cholecystectomy in the era of the 80 hour workweek. The problem isn’t its finding that quality improved after the workweek became shorter, but that it’s not possible to attribute [3]the improvement to residents sleeping more.

Using a retrospective trial design, the investigators compared complication rates at their hospital before and after the change to an 80 hour workweek. After accounting for age, gender and presence of acute cholecystitis, they found that the incidence of bile duct injury and total complications was lower after the rule change.

But why?  It may be that rested residents make all the difference. But it also could be that attending physician supervisors got more involved for whatever reason, or that the manpower alteration caused risky patients (where complications are most likely) to get procedures other than laporoscopic cholecystectomy.