The Influence of Intern Home Call on Objectively Measured Perioperative Outcomes | Medical Education and Training | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Griner D, Menon RP, Kotwall CA, Clancy TV, Hope WW. The eighty-hour workweek: surgical attendings' perspectives.  J Surg Educ. 2010;67(1):25-3120421086PubMedGoogle ScholarCrossref
Macgregor JM, Sticca R. General surgery residents' views on work hours regulations.  J Surg Educ. 2010;67(6):376-38021156294PubMedGoogle ScholarCrossref
Landrigan CP, Rothschild JM, Cronin JW,  et al.  Effect of reducing interns' work hours on serious medical errors in intensive care units.  N Engl J Med. 2004;351(18):1838-184815509817PubMedGoogle ScholarCrossref
Khuri SF, Daley J, Henderson W,  et al.  The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care.  J Am Coll Surg. 1995;180(5):519-5317749526PubMedGoogle Scholar
Khuri SF, Daley J, Henderson W,  et al.  Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study.  J Am Coll Surg. 1997;185(4):315-3279328380PubMedGoogle Scholar
Daley J, Khuri SF, Henderson W,  et al.  Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study.  J Am Coll Surg. 1997;185(4):328-3409328381PubMedGoogle Scholar
Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates.  Stat Med. 2000;19(3):335-35110649300PubMedGoogle ScholarCrossref
Dalton C. Reports of the Council on Medical Education. Accessed April 23, 2012
Kusuma SK, Mehta S, Sirkin M,  et al.  Measuring the attitudes and impact of the eighty-hour workweek rules on orthopaedic surgery residents.  J Bone Joint Surg Am. 2007;89(3):679-68517332119PubMedGoogle ScholarCrossref
Brunworth JD, Sindwani R. Impact of duty hour restrictions on otolaryngology training: divergent resident and faculty perspectives.  Laryngoscope. 2006;116(7):1127-113016826046PubMedGoogle ScholarCrossref
Peabody T. The effect of work hour restrictions on the education of orthopaedic surgery residents.  Clin Orthop Relat Res. 2006;449:128-13316735877PubMedGoogle Scholar
Kupferman TA, Lian TS. Implementation of duty hour standards in otolaryngology-head and neck surgery residency training.  Otolaryngol Head Neck Surg. 2005;132(6):819-82215944547PubMedGoogle ScholarCrossref
Gelfand DV, Podnos YD, Carmichael JC, Saltzman DJ, Wilson SE, Williams RA. Effect of the 80-hour workweek on resident burnout.  Arch Surg. 2004;139(9):933-938, discussion 938-94015381609PubMedGoogle ScholarCrossref
Chandra RK. The resident 80-hour work week: how has it affected surgical specialties?  Laryngoscope. 2004;114(8):1394-1398, discussion 131915280714PubMedGoogle ScholarCrossref
Vogel TR, Dombrovskiy VY, Lowry SF. Trends in postoperative sepsis: are we improving outcomes?  Surg Infect (Larchmt). 2009;10(1):71-7819298170PubMedGoogle ScholarCrossref
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000.  N Engl J Med. 2003;348(16):1546-155412700374PubMedGoogle ScholarCrossref
Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003.  Crit Care Med. 2007;35(5):1244-125017414736PubMedGoogle ScholarCrossref
Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations.  Crit Care Med. 2005;33(11):2555-256216276180PubMedGoogle ScholarCrossref
Original Article
April 2013

The Influence of Intern Home Call on Objectively Measured Perioperative Outcomes

Author Affiliations

Author Affiliations: Department of Surgery, Stanford University School of Medicine (Drs Kastenberg, Rhoads, Melcher, and Wren) and Palo Alto Veterans Health Care System (Dr Wren), Palo Alto, California.

JAMA Surg. 2013;148(4):347-351. doi:10.1001/jamasurg.2013.1063

Hypothesis In July 2011, surgical interns were prohibited from being on call from home by the new residency review committee guidelines on work hours. In support of the new Accreditation Council for Graduate Medical Education work-hour restrictions, we expected that a period of intern home call would correlate with increased rates of postoperative morbidity and mortality.

Design Prospective cohort.

Setting University-affiliated tertiary Veterans Affairs Medical Center.

Patients All patients identified in the Veterans Affairs National Surgical Quality Improvement Program database who underwent an operation performed by general, vascular, urologic, or cardiac surgery services between fiscal years (FYs) 1999 and 2010 were included.

Main Outcome Measures During FYs 1999-2003, the first call for all patients went to an in-hospital intern. In the subsequent period (FYs 2004-2010), the first call went to an intern on home call. Thirty-day unadjusted morbidity and mortality rates and risk-adjusted observed to expected ratios were analyzed by univariate analysis and joinpoint regression, respectively.

Results Unadjusted overall morbidity rates decreased between 1999-2003 and 2004-2010 (12.14% to 10.19%, =  .003). The risk-adjusted morbidity observed to expected ratios decreased at a uniform annual percentage change of −6.03% (P < .001). Unadjusted overall mortality rates also decreased between the 2 periods (1.76% to 1.26%; =  .05). There was no significant change in the risk-adjusted mortality observed to expected ratios during the study.

Conclusions The institution of an intern home call schedule was not associated with increased rates of postoperative morbidity or mortality.