Sleep-deprived surgeons may
be no more likely than rested ones to make an error during an operation the
next day, a new study suggests.
Canadian researchers found
that patients having gallbladder surgery were not at increased risk of
complications when their surgeon had handled an emergency operation overnight
instead of getting a full night's rest.
The findings, reported in the Journal of the American Medical Association,
come at a time when surgeons' work hours are under scrutiny.There are already limits in the United States and on how many hours surgical residents (surgeons
in training) can work. There's also been calls to curb senior surgeons'
hours -- one proposal is to bar them from scheduling an elective surgery on a
day after they had been on call overnight.
Lead researcher Dr Christopher Vinden, a general
surgeon at the London Health Sciences Centre Victoria Hospital in London, Ontario, said there were no new evidence to support that.
If anything, he said,
"it seems like self-regulation is working."
Vinden said surgeons who were truly too fatigued after an overnight case may cancel their elective surgery
for the next day, But that, he pointed out, is only one potential
explanation for the findings.
"What we know from the
[research] on sleep deprivation is that mundane tasks seem to be the most
affected," Vinden said.
"Surgery is not a
Dr Michael Zinner,
surgeon-in-chief at Brigham and Women's Hospital in Boston, agreed. "There
is nothing routine or monotonous about surgery," he said.
patient is different and each case is unique."
Based on past studies,
sleep deprivation does affect abilities like driving a car, noted Zinner, who
co-wrote an editorial published with the study. "But," he said,
"surgery is not like driving a car."
For the study, Vinden's
team looked at billing records of 331 general surgeons at 102 community
hospitals in Ontario. Those surgeons performed just more than 2 000 gallbladder removals on a day after they had operated overnight during a seven year period.
Vinden's team compared each
surgeon's results with those of four other gallbladder removals he or she had
done after a night off work and overall the researchers found no
differences in complication rates.
Around 2% of
patients had to be switched from minimally invasive "keyhole" surgery
to an invasive, open surgery during the procedure -- whether their surgeon had
operated the night before or not. Less than 1% suffered some kind of
injury that could be blamed on surgeon error -- like a puncture or cut in a
blood vessel or nearby organ.
Vinden said his team
focused on gallbladder removal because in the world of surgery, it's the
closest thing to "mundane."
"It's the most common
procedure that general surgeons do," Vinden said. If sleep deprivation
were to boost patients' complication risks, he said, you would expect to see
the effect in gallbladder removals.
Other, smaller studies have
found no extra risks to patients when their surgeon worked the night
before. "But none have been as well done, or as large, as this one,"
He added that the study
also focused on the "real rank-and-file" general surgeons who -- in
Canada and the United States -- handle the bulk of all surgeries done each
Zinner said he thinks the
public "can feel comforted" by the findings of this and other
studies. It's not even clear how often surgeons in this study
were truly sleep-deprived -- they could've operated after midnight, then gone
home and slept before doing a gallbladder removal the next afternoon.
And Zinner agreed with
Vinden that there is likely some "self-regulation" going on: Fatigued
surgeons do often tell their elective-surgery patient that they'll either have
to delay the procedure or have another surgeon do it.
"I've done it,"
Zinner said. "It's part of the professionalism."
Both he and Vinden said
that any laws curbing senior surgeons' hours would end up delaying many
operations. In smaller community hospitals especially, Zinner noted, there are
simply not enough surgeons.
The US Agency for
Healthcare Research and Quality has advice on making sure your surgery is safe.