Sleep Deprived Surgeons No Less Effective, Study Finds

Sleep deprivation may not have an adverse effect on surgeons because operating is not monotonous.

A new study finds sleep deprived surgeons are no less effective than those who did not work the night before an operation.
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Although sleep deprivation can be seen as detrimental in the medical world, surgeons who worked the night before an operation were no less effective and did not have a higher rate of complications in surgery than those who did not work the night before, according to a study published Tuesday.

By analyzing the performance of more than 300 surgeons, researchers at the Western University in Ontario, Canada, found that safety concerns related to surgeons operating the night before performing another procedure might not be supported.

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Researchers observed the procedures of 2,078 patients whose surgeons worked between midnight and 7 a.m. the night before. Then, they compared each patient with four other patients who experienced the same surgery by the same surgeon at a time when the surgeon had not operated the night before. As a result, there were no associated risks or complications, according to the study, led by Christopher Vinden, an associate professor at the university.

"Taken together, research in this area has not shown a relationship between complication rates and surgeon sleep the night before an operation is performed," the report says.

Also of concern is how the volume of patients doctors see in intensive care units affects patient care. When doctors are under more pressure and are busier, they could theoretically make more mistakes or discharge patients before they should. But a recent study from the University of Pennsylvania found the opposite.

When in a busy and high-pressure situation, ICU doctors did discharge patients more quickly, but did so without adversely affecting their outcomes. This may be a sign that pressure helps doctors more accurately assess patients' conditions, lead researcher Jason Wagner said in a previous interview.

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Although hours fluctuate between hospitals and surgical specialties, surgeons on average regularly work more than 40 hours each week, with some working up to 70 or 80 hours in a week.

Because sleep is so essential to basic biological functioning, and research has shown sleep deprivation can negatively affect how people perform routine tasks, policies have been put in place to limit the work hours of training surgeons, and similar proposals have been made for practicing surgeons, Vinden's study says. But limiting a surgeon's work hours is a controversial issue, the authors argue, because some believe it could have a negative impact on the quality and continuity of patient care.

"Restructuring health care delivery to prevent surgeons operating during the day after they operated the previous night would have important cost, staffing, and resource implications," the report says. "In some rural underserved areas, restricting surgeon work hours may not be possible without making care unavailable."

But limiting work hours might not be an issue for surgeons. In an editorial published with Vinden's study, Michael Zinner of Brigham and Women's Hospital in Boston, and Julie Fresichlag of the Johns Hopkins Medical Institute write that sleep deprivation does not have the same effect on surgeons as it does for other people, such as pilots, truck drivers or astronauts.

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"Virtually all studies have concluded that routine monotonous tasks can be adversely affected by limited amounts of sleep before the task," Zinner and Fresichlag write. "However, performing an operation is different from these more routine and repetitive activities. Operating is a highly focused skill that takes years of training and is not monotonous."

Still, Zinner and Fresichlag said it's up to the surgeons to self-assess their level of fatigue before performing surgery.

"Patient safety and surgeon well-being deserve no less," Zinner and Fresichlag write.

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