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Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek.

Publication ,  Journal Article
Smrtka, MP; Gunatilake, RP; Harris, B; Yu, M; Lan, L; Brancazio, LR; Valea, FA; Grotegut, CA; Brown, HL
Published in: J Grad Med Educ
September 2015

BACKGROUND: In 2003, the Accreditation Council for Graduate Medical Education limited resident duty hours to 80 hours per week. More than a decade later, the effect of the limits on resident clinical competence is not fully understood. OBJECTIVE: We sought to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery. METHODS: We reviewed unlabored primary cesarean deliveries at Duke University Hospital after 34 weeks gestation, between 2003 and 2011. Descriptive statistics and linear regression were used to compare total operative time with incision to delivery time as a function of years since institution of the 80-hour workweek. Resident training level, subject body mass index, estimated blood loss, and skin closure method were controlled for in the regression model. RESULTS: We identified 444 deliveries that met study criteria. The mean (SD) total operative time in 2003-2004 was 43.3 (14.3) minutes and 59.6 (10.7) minutes in 2010-2011 (P < .001). Multivariable regression demonstrated an increase in total operative time of 1.9 min/y (P < .001) but no change in incision to delivery time (P = .05). The magnitude of increased operative time was seen among junior residents (2.0 min/y, P < .001) compared to that of senior residents (1.2 min/y, P = .06). CONCLUSIONS: Since introduction of the 2003 duty hour limits, there has been an increase of nearly 20 minutes in the time required for a routine cesarean delivery. It is unclear if the findings are due to a change in residency duty hours or to another aspect of residency training.

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Published In

J Grad Med Educ

DOI

EISSN

1949-8357

Publication Date

September 2015

Volume

7

Issue

3

Start / End Page

369 / 375

Location

United States

Related Subject Headings

  • Workload
  • Work Schedule Tolerance
  • Time Factors
  • Personnel Staffing and Scheduling
  • Operative Time
  • Obstetrics and Gynecology Department, Hospital
  • North Carolina
  • Internship and Residency
  • Humans
  • Female
 

Citation

APA
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Smrtka, M. P., Gunatilake, R. P., Harris, B., Yu, M., Lan, L., Brancazio, L. R., … Brown, H. L. (2015). Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek. J Grad Med Educ, 7(3), 369–375. https://doi.org/10.4300/JGME-D-14-00364.1
Smrtka, Michael P., Ravindu P. Gunatilake, Benjamin Harris, Miao Yu, Lan Lan, Leo R. Brancazio, Fidel A. Valea, Chad A. Grotegut, and Haywood L. Brown. “Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek.J Grad Med Educ 7, no. 3 (September 2015): 369–75. https://doi.org/10.4300/JGME-D-14-00364.1.
Smrtka MP, Gunatilake RP, Harris B, Yu M, Lan L, Brancazio LR, et al. Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek. J Grad Med Educ. 2015 Sep;7(3):369–75.
Smrtka, Michael P., et al. “Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek.J Grad Med Educ, vol. 7, no. 3, Sept. 2015, pp. 369–75. Pubmed, doi:10.4300/JGME-D-14-00364.1.
Smrtka MP, Gunatilake RP, Harris B, Yu M, Lan L, Brancazio LR, Valea FA, Grotegut CA, Brown HL. Increase in Cesarean Operative Time Following Institution of the 80-Hour Workweek. J Grad Med Educ. 2015 Sep;7(3):369–375.

Published In

J Grad Med Educ

DOI

EISSN

1949-8357

Publication Date

September 2015

Volume

7

Issue

3

Start / End Page

369 / 375

Location

United States

Related Subject Headings

  • Workload
  • Work Schedule Tolerance
  • Time Factors
  • Personnel Staffing and Scheduling
  • Operative Time
  • Obstetrics and Gynecology Department, Hospital
  • North Carolina
  • Internship and Residency
  • Humans
  • Female