During 2006-2013, ulcerative colitis surgery patients were 38% more likely to die in the hospital and
51% more likely to experience a major postoperative event, compared with 1995-2005.
UC surgery outcomes worsen
due to shift in patient population
revised work hour limit
BY SUSAN KREIMER
Frontline Medical News
First-year residents may be permitted to work up to 24 consecutive hours – 8 hours longer than they can now – under a proposal from a task force of the
Accreditation Council for Graduate Medical Education
The ACGME Duty Hour Task Force proposes to raise
first-year trainees’ work hour limit from 16 hours, reverting to the 24-hour maximum that remained in effect until
2011 – and the existing limit in place for all other residents.
The proposed changes are “encouraging and courageous,” according to R. James Valentine, MD, FACS, president of the Western Surgical Association.
“This is a real world scenario,” said Dr. Valentine, profes-
sor of vascular surgery at Vanderbilt University, Nashville,
Tenn. “Medicine is such a complex system. It is not easily
constrained by time limitations.”
Requiring a physician to transition a patient’s care at a
specific time may help promote the trainee’s well-being;
however, it also “robs the resident of the opportunity to
see the disease progress and to see the response to the
treatment that is being offered. The new rules help strike a
balance between bedside education and rest,” he added.
The ACGME instituted the 16-hour cap for first-year
residents in the wake of a December 2008 report released
by the Institute of Medicine (IOM), “Resident Duty Hours:
Enhancing Sleep, Supervision, and Safety.” The ACGME
VOL. 12 • NO. 12
See ACGME Â page 7
5 l From the Editors
Karen E. Deveney, MD, FACS,
says the ACS Clinical Congress
has something for everyone.
10 l News from the College
Barbara Lee Bass, MD, FACS, has been
chosen as ACS President-Elect.
15 l Practice Management
Benjamin T. Jarmen, MD, FACS,
reports on a chief resident service.
Online & In-Depth
Should surgeons change gloves during
laparoscopic hysterectomy? Maria E.
Shockley MD, spoke on the topic at the AAGL
meeting. Read the story at goo.gl/0g YNBi.
BY MICHELE G. SULLIVAN
Frontline Medical News
AT THE ACS CLINICAL CONGRESS
WASHINGTON – The era of powerful biologics has led to unforeseen surgical outcome
trends in patients with ulcerative colitis.
Patients undergoing surgery for ulcerative
colitis now are 38% more likely to die in the
hospital than they were 15 years ago, before
infliximab and other biologics were adopted
as medical therapy for the disease. A database
review covering 18 years found that other sur-
gical outcomes are worse, too, Jonathan Abel-
son, MD, said at the annual Clinical Congress
of the American College of Surgeons.
The drugs themselves are not creating the
poor outcomes per se, Dr. Abelson said in an
interview. Rather, biologics are controlling
inflammatory bowel disease well in patients
with mild-moderate disease, and leaving the
sickest patients in the surgical pool.
“These very powerful agents could be completely eliminating the need for surgery in
patients with mild disease, leaving surgery for
See Ulcerative colitis Â page 7
New rules mean longer shifts allowed.
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Transplantation Palliative Care
Geoffrey P. Dunn, MD, FACS, and Daniel Azoulay, MD,
make the case for the integration of palliative care
and practice in the field of transplantation surgery.
Collaboration between specialists in this field is long
overdue in light of the needs of patients and their
families during the transplantation process.
Â page 8