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82: Increase in cesarean operative times following institution of the 80-hour work week

      Objective

      In 2003, the Accreditation Council for Graduate Medical Education (ACGME) limited resident duty hours to 80 hours per week. The aim of this study was to assess the effect of duty hour restrictions on resident performance of an uncomplicated cesarean delivery, using operative times as a proxy for proficiency.

      Study Design

      All unlabored primary cesarean deliveries performed at our hospital after 34 weeks gestation between 2003 and 2011 were reviewed retrospectively. Women with multiple gestations, prior pelvic surgery, or undergoing additional procedures at delivery were excluded. Descriptive statistics and linear regression were used to compare total operative time (primary outcome) and incision-to-delivery time (secondary outcome) as a function of years since institution of the “80-hour work week”. Resident training level (junior / senior), subject body mass index, estimated blood loss, and skin closure method were included in the regression model. Comparisons were also made between junior (PGY 1-2) and senior (PGY 3-4) residents.

      Results

      We identified 444 unlabored primary cesarean deliveries that met study criteria. Over the study period, no significant changes in training level allocation of cesarean cases were observed. Mean (SEM) total operative time in 2003-04 was 43.3 (2.2) minutes and in 2010-11 was 59.6 (1.8) minutes (p <0.0001). Linear regression demonstrated rate increases in total operative time of 1.9 min/year (p<0.0001) and incision to delivery time of 0.2 min/year (p<0.05). The magnitude of increased total operative time was more pronounced among junior residents (2.0 min/year; p<0.0001) than senior residents (1.2 min/year; p = 0.06).

      Conclusion

      There has been a steady increase in the time required to perform a routine cesarean delivery, such that an additional 20 minutes will be needed to perform the same surgery a decade after introduction of the “80-hour work week”. As additional residency duty hour limitations are considered, careful attention to adequate surgical exposure must also be weighed.