The effects of sleep deprivation on surgeons and their patients

If the surgeon worked last night, do you want him to surgery the next day? The answer to whether a dream is a private surgeon surgeon can safely surprise, a recent study published in the New England Journal of Medicine.

During the last decade, concerns about lack of doctors in sleep practices and possible medical errors made changes in the number of consecutive hours the student can stay in the hospital.  

While this is safer, in theory, but also led to the concern that the limited hours in the hospital may also limit the experience of a student and to produce doctors who are not as well prepared they could be. This concern is especially important for physicians based on procedures such as surgeons whose skills often improves in proportion to the number of operations performed.

To cope with the effects of sleep loss on surgical outcomes, Dr. Anand Govindarajan, cancer surgeon and assistant at Mount Sinai Hospital and the Institute for Clinical Evaluative Sciences and the professor of Toronto, conducted a study of Billing data from the hospital involving about 40,000 patients in Canada who underwent 12 kinds of elective procedures. Operations vary in complexity and ranged from removal of the gallbladder bypass surgery.

Dr. Govindarajan and his team reviewed preliminary data of about 20,000 patients who had surgery performed by a doctor who had operated on last night between the hours of midnight and 7:00 (This is known as the Night Guard group). Then for every patient with any of the other 20,000 patients who had the same operation performed by the same surgeon, when he or she has not operated the day before. (This was nicknamed the group guard night nonprofit). The researchers found that both groups of patients also do well.  

Comparing the night guard group with no night guard group, there were no significant differences in mortality rate (1.1% in both groups), readmission (6.6% against 7 , 1%) or complications (18.1% vs 18.2%) within 30 days of surgery. This conclusion was unchanged even after the researchers took into account differences in patients' sex, age, socioeconomic status, and other health conditions that may have had.

The study by Dr. Govindarajan has implications for patients and policy makers. Contrary to intuitive thinking, patients do as well when a surgeon worked the night before surgery and when he or she did not. For patients, the study is reassuring and it means one less thing to worry before surgery. The message to politicians is that place regulations Surgeons night call can not improve security, and can even increase the cost.

Of course, although the study suggests that surgeons sleep loss may not be as harmful to patients the results one might think, the authors acknowledge that other factors also contributed to the results. For example, surgeons may be canceled tomorrow procedures if they felt they could not do their job safely or have scheduled a lighter day for calling tonight.  

Yet the study shows that patient safety is not compromised. It is also important to note that in this study, surgeons were all fully licensed doctors, not the students, and the students are the same doctors most likely to be limited hospital in time. Compared to participants, licensed physicians probably more experience and can not be as affected by sleep deprivation.
By: Anant Mandawat, MD,