Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons

Rachel R. Kelz*, Bijan A. Niknam, Morgan M. Sellers, James E. Sharpe, Paul R. Rosenbaum, Alexander S. Hill, Hong Zhou, Lauren L. Hochman, Karl Y. Bilimoria, Kamal Itani, Patrick S. Romano, Jeffrey H. Silber

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objective:The aim of the study was to address the controversy surrounding the effects of duty hour reform on new surgeon performance, we analyzed patients treated by new surgeons following the transition to independent practice.Summary Background Data:In 2003, duty hour reform affected all US surgical training programs. Its impact on the performance of new surgeons remains unstudied.Methods:We studied 30-day mortality among 1,483,074 Medicare beneficiaries undergoing general and orthopedic operations between 1999 and 2003 ("traditional" era) and 2009 and 2013 ("modern" era). The operations were performed by 2762 new surgeons trained before the reform, 2119 new surgeons trained following reform and 15,041 experienced surgeons. We used a difference-in-differences analysis comparing outcomes in matched patients treated by new versus experienced surgeons within each era, controlling for the hospital, operation, and patient risk factors.Results:Traditional era odds of 30-day mortality among matched patients treated by new versus experienced surgeons were significantly elevated [odds ratio (OR) 1.13; 95% confidence interval (CI) (1.05, 1.22), P < 0.001). The modern era elevated odds of mortality were not significant [OR 1.06; 95% CI (0.97-1.16), P = 0.239]. Relative performance of new and experienced surgeons with respect to 30-day mortality did not appear to change from the traditional era to the modern era [OR 0.93; 95% CI (0.83-1.05), P = 0.233]. There were statistically significant adverse changes over time in relative performance to experienced surgeons in prolonged length of stay [OR 1.08; 95% CI (1.02-1.15), P = 0.015], anesthesia time [9 min; 95% CI (8-10), P < 0.001], and costs [255USD; 95% CI (2-508), P = 0.049].Conclusions:Duty hour reform showed no significant effect on 30-day mortality achieved by new surgeons compared to their more experienced colleagues. Patients of new surgeons, however, trained after duty hour reform displayed some increases in the resources needed for their care.

Original languageEnglish (US)
Pages (from-to)599-605
Number of pages7
JournalAnnals of surgery
Issue number4
StatePublished - Apr 1 2020


  • duty hour reform
  • surgical education
  • surgical outcomes

ASJC Scopus subject areas

  • Surgery


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