For surgical interns, being on call from home is not associated with increased rates of postoperative morbidity or mortality, according to a study published in JAMA Surgery (2013;148:347-351).
Zachary J. Kastenberg, MD, from Stanford University School of Medicine in Palo Alto, Calif., and colleagues identified all patients from 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. Outcomes were compared for FYs 1999 to 2003, in which first calls for patients went to an in-hospital surgical intern versus FYs 2004 to 2010 when calls went to a surgical intern on home call.
The researchers found that there was a significant decrease in unadjusted overall morbidity rates from 1999-2003 to 2004-2010 (12.14% to 10.19%). The study found a significant uniform annual percentage change of −6.03% for risk-adjusted morbidity observed to expected ratios. Between the two periods, unadjusted overall mortality rates also decreased (1.76% to 1.26%). During the study, the risk-adjusted mortality observed to expected ratios did not change significantly.
“This study illustrates the need to incorporate objective evidence into the design of future resident staffing policy,” the investigators wrote. “Just as evidence-based practice has become the doctrine of modern medicine, so too should evidence dictate the policies governing our surgical training programs.”