Kimon Bekelis1,2, Symeon Missios3, Todd A MacKenzie2,4,5. 1. Department of Neurosurgery, Jefferson Hospital for the Neurosciences, Philadel-phia, Pennsylvania. 2. The Dartmouth In-stitute for Health Policy and Clinical Practice, Lebanon, New Hampshire. 3. Neu-roscience Institute, Cleveland Clinic/Akron General Hospital, Akron, Ohio. 4. Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 5. Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Abstract
BACKGROUND: The association between long work hours and outcomes among attending surgeons remains an issue of debate. OBJECTIVE: To investigate whether operating emergently the night before an elective case was associated with inferior outcomes among attending neurosurgeons. METHODS: We executed a cohort study with unruptured cerebral aneurysm patients, who underwent endovascular coiling or surgical clipping from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System database. We investigated the association of treatment by surgeons performing emergency procedures the night before with outcomes of elective cerebral aneurysm treatment using an instrumental variable analysis. RESULTS: Overall, 4700 patients underwent treatment for unruptured cerebral aneurysms. There was no difference in inpatient mortality (adjusted difference, -0.7%; 95% confidence interval [CI], -1.4% to 0.02%), discharge to a facility (adjusted difference, -0.1%; 95% CI, -1.2% to 1.2%), or length of stay (adjusted difference, -0.58; 95% CI, -1.66 to 0.50) between patients undergoing elective cerebral aneurysm treatment by surgeons who performed emergency procedures the night before, and those who did not. CONCLUSION: Using a comprehensive patient cohort in New York State for elective treatment of unruptured cerebral aneurysms, we did not identify an association of treatment by surgeons performing emergency procedures the night before, with mortality, discharge to a facility, or length of stay. Our study had 80% power to detect differences in mortality (our primary outcome), as small as 4.1%. The results of the present study do not support the argument for regulation of attending work hours.
BACKGROUND: The association between long work hours and outcomes among attending surgeons remains an issue of debate. OBJECTIVE: To investigate whether operating emergently the night before an elective case was associated with inferior outcomes among attending neurosurgeons. METHODS: We executed a cohort study with unruptured cerebral aneurysmpatients, who underwent endovascular coiling or surgical clipping from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System database. We investigated the association of treatment by surgeons performing emergency procedures the night before with outcomes of elective cerebral aneurysm treatment using an instrumental variable analysis. RESULTS: Overall, 4700 patients underwent treatment for unruptured cerebral aneurysms. There was no difference in inpatient mortality (adjusted difference, -0.7%; 95% confidence interval [CI], -1.4% to 0.02%), discharge to a facility (adjusted difference, -0.1%; 95% CI, -1.2% to 1.2%), or length of stay (adjusted difference, -0.58; 95% CI, -1.66 to 0.50) between patients undergoing elective cerebral aneurysm treatment by surgeons who performed emergency procedures the night before, and those who did not. CONCLUSION: Using a comprehensive patient cohort in New York State for elective treatment of unruptured cerebral aneurysms, we did not identify an association of treatment by surgeons performing emergency procedures the night before, with mortality, discharge to a facility, or length of stay. Our study had 80% power to detect differences in mortality (our primary outcome), as small as 4.1%. The results of the present study do not support the argument for regulation of attending work hours.
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