Impact of work hour restrictions on the operative experience of general surgical residents: A systematic review.

Introduction: Work hour restrictions (WHR) have been implemented globally to improve resident safety and welfare, but many in the surgical community have raised concerns regarding the impact on resident education and operative experience. This systematic review aims to investigate the impact of WHR on general surgical resident operative caseload. Materials and methods: Medline and Embase databases were systematically searched according to PRISMA guidelines to identify articles published between 2003 and 2022 assessing the impact of WHR on the operative experience of general surgical residents. Articles were only included if they reported on quantitative measures of operative experience and examined operative caseload after the introduction of WHR. Results: Of 1,266 studies identified, 26 studies were included, with the majority from US literature. Total major cases underwent a 0.6 % decrease after the introduction of WHR, with surgeon chief cases undergoing a 3.3 % decrease and surgeon junior cases undergoing a 3.7 % increase. Operative trauma underwent the greatest decrease at 18.4 %. Skin & soft tissue cases underwent the greatest increase at 67.6 %. Discussion: While WHR were often associated with reduced operative caseload in the early years following implementation, the majority of studies found a significant reduction was avoided in the long-term as training programs likely adapted to the new environment. These findings are of particular significance to countries considering the introduction of WHR for surgical residents and may guide future policy and decision-making. Conclusions: This review demonstrated no significant change in total major cases and an increased caseload for most operative subcategories after the introduction of WHR for general surgical residents. These findings are in keeping with a previous review published in 2011.