Changes in operative and in-hospital outcome of proximal femoral fractures before and after the implementation of work hour restrictions in Switzerland
4 affiliations
- 1University of Zurich, Zurich, Switzerland
- 2Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Zurich, Switzerland
- 3Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland
- 4Surgical Center, Hirslanden Klinik, Zurich, Switzerland
Abstract
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.
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BibTeX
@article{tewes2026changes,
title = {{Changes in operative and in-hospital outcome of proximal femoral fractures before and after the implementation of work hour restrictions in Switzerland}},
author = {Alexandra Tewes and Claudio Canal and Othmar Schöb and Valentin Neuhaus},
journal = {European Journal of Trauma and Emergency Surgery},
year = {2026},
month = may,
doi = {10.1007/s00068-026-03204-6},
url = {https://doi.org/10.1007/s00068-026-03204-6},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Changes in operative and in-hospital outcome of proximal femoral fractures before and after the implementation of work hour restrictions in Switzerland
AU - Alexandra Tewes
AU - Claudio Canal
AU - Othmar Schöb
AU - Valentin Neuhaus
PY - 2026
DA - 2026/05/13
JO - European Journal of Trauma and Emergency Surgery
DO - 10.1007/s00068-026-03204-6
UR - https://doi.org/10.1007/s00068-026-03204-6
AB - 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.
SN - 1863-9933
SN - 1863-9941
ER -