Resident work hour reforms: implications regarding hip fracture surgery

Abstract

Background: Resident work hour reforms were developed by Aga Khan University Postgraduate Medical education committee in the year 2005. These reforms were implemented by the section of Orthopedics in winter 2006. We designed this study to determine if there is a difference in morbidity and mortality following Dynamic Hip Screw (DHS) fixation for intertrochanteric fracture patients before and after implementation of work hour reforms.

Methods: Patients who underwent DHS fixation for inter-trochanteric fracture from January 2005 to December 2008 were included. These patients were divided into two groups. Group A included those patients who underwent DHS fixation prior to the implementation of work hour reforms and Group B patients had their hip fracture surgery after the implementation of these reforms.

Results: The mean operative time was 1.6±0.6 h and 1.3±0 h for group A and B patients respectively (p<0.001). There was no change in the rates of wound infection, length of hospital stay, post operative ambulation status, inadequate fixation, repeat surgeries and mortality in the two groups.

Conclusion: Resident work hour reform was associated with a significant decrease in the mean operative time for patients undergoing DHS fixation. However morbidity and mortality following DHS fixation for Intertrochanteric fractures has not decreased after implementation of these reforms. Further research evaluating patient outcomes in orthopedic surgery following work-hour restrictions are needed. Moreover, the impact of these reforms on the educational and research activities of the residents also needs to be determined.