Having surgery is nerve wracking enough even if your surgeon has had a great night’s sleep but what if your surgeon hadn’t slept well the night before, what if they had just operated late the night before, would you not be even more nervous about your operation? Most people would. It turns out that surgeons who operated the evening before they were due to do a daytime surgical operation did not have a higher rate of complications than those who had operated the night before.
Maybe not so tired
The study, published in the November 6 issue of JAMA, suggests that concerns over the hours that surgeons work may not be as valid as they have long been seen to be. The study states that "Lack of sleep is associated with impaired performance in many situations [and to] theoretically prevent medical errors, work-hour restrictions on surgeons in training were imposed. There are now proposals for similar work-hour restrictions on practicing surgeons. Several studies found no association between surgeon sleep deprivation as assessed by operating the night prior to an operation or when surgeons report few hours of sleep and patient outcomes.”
Earlier studies on the same topic are problematic due to their small sample size and because they were done by single academic bodies. Up until now this mean that there was not enough evidence to decide whether a surgeon’s ability had been compromised due to a lack of sleep the night before. This in turn lead to decisions being made on common sense and the assumption that operating the night before must have some impact on the next day’s surgery.
While the previous studies were limited in size and scope this study was much larger, looking at over 2000 patients in over 100 hospitals. The study focused on looking for any association between surgeons who had worked on operations the night before performing an elective cholecystectomy (gallbladder removal) the next day and complications. The study was conducted by using the administrative health care databases in Ontario.
Each of these 2078 patients who was operated on by a surgeon who had operated the night before was then paired with 4 other elective laparoscopic cholecystectomy recipients that had been performed by the same surgeon when they had not operated the overnight before. The findings were that there was no statistical difference in complications rates between those patients whose surgeon had operated the night before and those who hadn’t.
The authors of the study believe that the policies that are aimed at limiting attending surgeon work hours are problematic in light of their findings, writing that "Critics suggest such policies reduce continuity in care, increase communication errors, and introduce the potential for a bystander effect. 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." They also conclude that "These findings do not support safety concerns related to surgeons operating the night before performing elective surgery."
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