Surgical residents at a large teaching hospital who worked shorter shifts were less likely to make mistakes during gallbladder surgery, U.S. researchers said on Monday.

The study offers some of the first evidence that rules put into place in 2003 to limit hours worked by doctors in training resulted in better care for patients. Many doctors have argued that the limits interfere with the training of doctors but make no difference in patient care.

“We are actually surprised to find the outcomes improved,” Dr. Christian de Virgilio of the Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles Medical Center said in a telephone interview.

“Our study is essentially the first that has shown there is some improvement in outcomes in this new era,” said de Virgilio, whose study appears in the Archives of Surgery.

The Institute of Medicine, which advises U.S. policymakers on medical issues, is expected to release new recommendations later this year about how medical residents’ schedules should be changed to improve patient safety.

Current guidelines call for a maximum shift of 30 hours, and a maximum 80-hour work week. A study last week in the Journal of the American Medical Association found the schedule change had little impact on death rates among elderly patients covered by Medicare, the government health insurance program for people 65 and older.

De Virgilio’s team studied the medical records of 2,470 patients who had undergone laparoscopic gallbladder surgery. About half of the operations were performed before the change in hours, and the other half were performed after the change.

All were done by residents who were supervised by staff physicians. The researchers tracked the number of patients who had bile duct injuries, a common complication with laparoscopic or “keyhole” surgery that can arise from technical error.

Di Virgilio said studies using simulators have shown sleep deprivation can erode medical residents’ laparoscopic skills.

“We suspected that the outcomes would have been the same before and after,” De Virgilio said. Instead, the complication rate decreased.

De Virgilio said he thinks the move to an 80-hour week is likely a good change, but he is wary of any further cuts.

“There has been talk about cutting duty hours to 56 hours,” he said, referring to the weekly limit now used in Europe.

He thinks that would result in poorly prepared surgeons.

“You are not just learning the medical care of patients. You are learning the trade or the craft of becoming a surgeon. That is where the hours become an issue,” he said.

By Julie Steenhuysen
CHICAGO (Reuters)