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 19 January 2018

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News

Decreased bile duct injury during laparoscopy with restricted working hours

Rates of bile duct injury during laparoscopic cholecystectomy are lower in the era of the 80-Hour resident workweek, finds the most recent Archives of Surgery.

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Considerable concern has been raised about the effects of restricted duty hours on surgical training.

The effect of the 80-hour resident workweek on operative outcomes after laparoscopic cholecystectomy has not been well studied.

Dr Arezou Yaghoubian and colleagues from California, USA compared the rates of bile duct injury and overall complications after laparoscopic cholecystectomy before and after the institution of the duty-hour restriction.

Period 1 included the time from 2001 to 2003 and Period 2 included the institution of duty-hour restrictions between 2003 and 2006

The research team conducted a retrospective review of patient medical records to determine morbidity and mortality before and after implementation of duty hour limitations.

The team assessed a total of 2470 patients who had undergone laparoscopic cholecystectomy.

The incident of total complications decreased from 5% to 2%
Archives of Surgery

Bile duct injury and overall complication rates as determined using multivariate analysis.

The researcher noted that overall, 2,470 laparoscopic cholecystectomy procedures, including 1,353 in Period 1 and 1,117 in Period 2, were performed.

In Period 2, more patients had acute cholecystitis as the indication for surgery, and a higher percentage of patients were male.

The team found the incidence of bile duct injury and total complications decreased in Period 2 from 1% to 0.4% and from 5% to 2%, respectively.

Mortality was unchanged.

Multivariate analysis revealed that Period 2 was protective for bile duct injury.

For complications, the team noted that both female sex and surgery during Period 2 were protective.

However, the researchers found that older age was associated with complications.

Dr Yaghoubian’s team concluded, “At a major public teaching hospital, the bile duct injury rate and the overall complication rate decreased after implementation of the 80-hour workweek.”

Arch Surg 2008: 143(9): 847-51


22 September 2008

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