A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes.
Level 2 - randomized trial
Systematic review and meta-analysis of predominantly observational and cohort studies
PubMed 24662409 · doi:10.1097/SLA.0000000000000595
What was done
A systematic review (searching CINAHL, Cochrane Database, Embase, Medline, and Scopus from 1980 to 2013) evaluated the impact of ACGME resident duty hour regulations (the 2003 80-hour limit and 2011 16-hour PGY1 limit) on clinical and educational outcomes in surgery. Study quality was appraised using GRADE. Sixteen-hour shifts and night float systems were evaluated separately, and studies reporting mortality were combined in a random-effects meta-analysis.
What was found
A total of 135 articles met inclusion criteria; 42% (n = 57) were classified as moderate-to-high quality. Duty hour limits produced no overall improvement in patient outcomes, though some studies suggested increased complication rates in high-acuity patients. No educational benefits were observed, and performance on certification examinations declined in some specialties. Survey studies reported perceptions of worsened education and patient safety. Resident wellness improved after the 80-hour workweek mandate, but the 16-hour shift limit showed little improvement or negative effects on wellness. The abstract provides no specific numerical effect sizes, pooled odds ratios, or confidence intervals.
Why it matters
Mandated duty hour reductions were intended to enhance safety and well-being, but this synthesis indicates that rigid limits have not improved surgical patient outcomes or education, highlighting trade-offs in surgical training continuity.
Limits
The abstract reports no numerical estimates or confidence intervals for the meta-analysis. Most included studies (58%) were low quality, and many educational and safety findings relied on subjective survey perceptions rather than objective clinical metrics.
Cited by
- supports Medical residency work hours in the United States were historically reduced from up to 120 hours per week to an 80-hour weekly cap.