Abstract
Objective
To determine whether obstetrical patient outcomes have changed following the introduction
of restricted resident work hours.
Methods
A population-based retrospective cohort study of the effects of restricted duty hours
for residents in July 2013 at three academic hospitals in Toronto, ON using linked
health care databases. The study included 6763 deliveries in the 2 years pre-exposure
and 5548 deliveries in the 2 years post-exposure.
Results
The primary outcome, planned prior to data collection, was a composite index of 29
maternal/fetal outcomes including maternal transfusion/postpartum hemorrhage, maternal
infection, fetal mortality, NICU admissions, and surgical/obstetrical complications.
There were seven secondary outcomes analysed: NICU admissions; neonatal death; maternal
transfusion or postpartum hemorrhage; maternal infection; and three composite measures.
A generalized estimating equation model, clustered by institution, was utilized to
assess for differences post-intervention. We found no significant differences in baseline
demographics between groups. After the implementation of duty hour restrictions, no
significant difference was seen in the primary outcome. However, an increased incidence
of composite maternal surgical/obstetrical outcomes (OR 1.191; 95% CI 1.037–1.367,
P = 0.013) and transfusion/postpartum hemorrhage (OR 1.232; 95% CI 1.074–1.413, P = 0.003) was found. There were no significant differences in other secondary outcomes.
Conclusion
Since the implementation of resident duty hour restrictions, there was no overall
change in patient outcomes. However, there was an increase in surgical/obstetrical
complications and transfusion/postpartum hemorrhage. This suggests that duty hour
restrictions may not be beneficial to patient outcomes. It highlights the need to
further investigate the clinical impact of a change in resident duty hours.
Résumé
Objectif
Déterminer si la restriction des heures de travail des résidents a eu un effet sur
les résultats de santé des patientes en obstétrique.
Méthodologie
Nous avons interrogé des bases de données de soins de santé liées pour mener une étude
de cohorte rétrospective basée sur la population portant sur les effets de la restriction
des heures de travail des résidents en juillet 2013 dans trois hôpitaux universitaires
de Toronto (Ontario). Nous nous sommes penchés sur 6763 accouchements survenus dans
les deux ans précédant la restriction et sur 5548 accouchements survenus dans les
deux ans suivant celle-ci.
Résultats
Le résultat primaire à l'étude, choisi avant la collecte de données, était un indice
composé de 29 issues maternelles et fœtales, dont la transfusion maternelle et l'hémorragie
de la délivrance, l'infection maternelle, la mortalité fœtale, l'admission à l'UNSI
et les complications chirurgicales et obstétricales. Sept résultats secondaires ont
également été étudiés : l'admission à l'UNSI, le décès néonatal, la transfusion maternelle
et l'hémorragie de la délivrance, l'infection maternelle et trois mesures composées.
Un modèle d'équation d'estimation généralisée regroupant les données par établissement
a été utilisé pour évaluer les différences post-intervention. Aucune différence significative
n'a été observée entre les groupes quant aux caractéristiques démographiques de référence.
Nous n'avons observé aucun changement significatif du résultat primaire après la restriction
des heures de travail, mais avons constaté une augmentation de la mesure composée
pour les complications chirurgicales et obstétricales maternelles (RC : 1191; IC à
95 % : 1037–1367; P = 0,013) et des transfusions et des hémorragies de la délivrance (RC : 1232; IC à
95 % : 1074–1413; P = 0,003). Aucune différence significative n'a été observée quant aux autres résultats
secondaires.
Conclusion
La restriction des heures de travail des résidents n'a pas eu d'effet sur les résultats
de santé des patientes. Une augmentation des complications chirurgicales et obstétricales
ainsi que des transfusions et des hémorragies de la délivrance a toutefois été constatée.
Ces résultats laissent penser que la restriction des heures de travail pourrait ne
pas être avantageuse sur le plan des résultats de santé des patientes, et mettent
en évidence le besoin d'étudier davantage les effets cliniques des changements apportés
aux heures de travail des résidents.
Key Words
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Article info
Publication history
Published online: July 16, 2018
Accepted:
January 30,
2018
Received:
December 7,
2017
Footnotes
Competing interests: The authors declare that they have no competing interests.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
