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Purpose <p>Surgeon fatigue is a recognized risk factor for patient safety; however, reduced working hours may limit surgical training exposure. In 2005, Switzerland introduced a maximum 50-hour workweek for resident surgeons. In view of current discussions on further reductions (42 + 4&#xa0;h), concerns persist regarding training quality and workforce capacity. This study evaluates the impact of the 2005 Swiss labor law on patient outcomes, operative characteristics, and intraoperative teaching utilizing a standardized trauma procedure.</p> Methods <p>A retrospective analysis of anonymized data from a national database was performed. All patients undergoing operative fixation of trochanteric femur fractures (ICD-10 S72.1) were included. Two four-year periods were compared: pre-regulation (2001–2004) and post-regulation (2016–2019). Primary endpoints were in-hospital complications, mortality, and length of stay. Secondary endpoints included patient characteristics, surgeon seniority, teaching status, operative duration, and time to surgery.</p> Results <p>Post-regulation patients were older and exhibited higher American Society of Anesthesiologists classifications despite fewer comorbidities. Complications increased from 9.1% to 17.7%, and mortality from 1.6% to 3.5%. Length of stay decreased from 14 to 9 days. Operative duration decreased by 10&#xa0;min across all surgeon levels. Resident surgeons independently performed 10% fewer procedures, but teaching operations increased significantly among resident surgeons.</p> Conclusion <p>Following the introduction of working hour limitations, supervised teaching increased substantially. Although complication and mortality rates rose—likely reflecting an older and more complex patient population—hospital stays shortened. The proposed 42 + 4-hour model will require targeted compensatory measures to maintain surgical training quality and patient safety.</p>

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Changes in operative and in-hospital outcome of proximal femoral fractures before and after the implementation of work hour restrictions in Switzerland

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • Alexandra Tewes,
  • Claudio Canal,
  • Othmar Schöb,
  • Valentin Neuhaus

摘要

Purpose

Surgeon fatigue is a recognized risk factor for patient safety; however, reduced working hours may limit surgical training exposure. In 2005, Switzerland introduced a maximum 50-hour workweek for resident surgeons. In view of current discussions on further reductions (42 + 4 h), concerns persist regarding training quality and workforce capacity. This study evaluates the impact of the 2005 Swiss labor law on patient outcomes, operative characteristics, and intraoperative teaching utilizing a standardized trauma procedure.

Methods

A retrospective analysis of anonymized data from a national database was performed. All patients undergoing operative fixation of trochanteric femur fractures (ICD-10 S72.1) were included. Two four-year periods were compared: pre-regulation (2001–2004) and post-regulation (2016–2019). Primary endpoints were in-hospital complications, mortality, and length of stay. Secondary endpoints included patient characteristics, surgeon seniority, teaching status, operative duration, and time to surgery.

Results

Post-regulation patients were older and exhibited higher American Society of Anesthesiologists classifications despite fewer comorbidities. Complications increased from 9.1% to 17.7%, and mortality from 1.6% to 3.5%. Length of stay decreased from 14 to 9 days. Operative duration decreased by 10 min across all surgeon levels. Resident surgeons independently performed 10% fewer procedures, but teaching operations increased significantly among resident surgeons.

Conclusion

Following the introduction of working hour limitations, supervised teaching increased substantially. Although complication and mortality rates rose—likely reflecting an older and more complex patient population—hospital stays shortened. The proposed 42 + 4-hour model will require targeted compensatory measures to maintain surgical training quality and patient safety.