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Resident Duty-Hour Reform Associated with Increased Morbidity Following Hip Fracture

¹ Division of Orthopaedic Surgery, DUMC Box 3000, Orange Zone, Duke Clinics Building, Trent Drive, Duke University Medical Center, Durham, NC 27710
² Department of Surgery, Duke University Medical Center, DUMC Box 3907, Durham, NC 27710
³ Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, 2504 Duke South Blue Zone, Durham, NC 27710
⁴ Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, DUMC Box 3269, Room 5316, Duke Clinics Building, Durham, NC 27710

Investigation performed at the Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Zimmer, DePuy, and Wright Medical).

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Methods: The Nationwide Inpatient Sample database was used to identify 48,430 patients treated for hip fracture during the years of 2001 to 2002, before resident duty-hour reform, and the years of 2004 to 2005 after reform. Logistic regression was used to examine the change in morbidity and mortality in nonteaching compared with teaching hospitals before and after the reform, adjusting for patient characteristics and comorbidities.

Results: An increase in the overall incidence of perioperative morbidity was observed in both teaching and nonteaching hospitals, suggesting a general increase in the severity of illness of the patients with a hip fracture. A significant increase in the rate of change in the incidence of perioperative pneumonia, hematoma, transfusion, renal complications, nonroutine discharge, costs, and length of stay was seen in patients who underwent treatment for a hip fracture in the years after the resident duty-hour reforms at teaching institutions. Resident duty-hour reform was not associated with an increase in mortality.

Conclusions: Resident duty-hour reform was associated with an accelerated rate of increasing patient morbidity following treatment of hip fractures in teaching institutions. Further research into this concerning finding is needed.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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