Sleep-deprived doctors in surgery no cause for concern, Ontario study finds
Imagine you’re in hospital, about to undergo scheduled coronary-artery bypass surgery. As the anesthetist begins to put you under, you learn that your surgeon just finished an overnight shift.
Would you be impressed by his stamina? Disconcerted? Terrified?
According to a new Ontario study — the largest ever done on the effects of sleep deprivation on staff physicians and surgeons — you have nothing to fear.
A patient who undergoes an elective daytime procedure at the hands of a physician who worked between midnight and 7 a.m. is no more likely to die, suffer complications or be readmitted to hospital than if treated by the same fully rested doctor, says the study from Toronto’s Institute for Clinical Evaluative Sciences.
The study, published Wednesday in the New England Journal of Medicine, looked at nearly 39,000 patients who underwent one of 12 procedures — ranging from bypass and spinal surgery to hip and knee replacements — at 147 Ontario hospitals between 2007 and 2011.
They were treated by 1,448 different physicians. Half of the daytime patients were treated by physicians who had provided overnight medical care. They were matched with an equal number of patients who received the same elective procedures from the same well-rested physicians.
The rate of death, readmission or complication was virtually identical between the two groups. Nor were there any significant differences in outcomes based on the physician’s age or the type of procedure.
The study found a “small but significant” increase in complications among patients whose physicians had performed two or more procedures the night before.
But, it concluded, “Overall, the risks of adverse outcomes of elective daytime procedures were similar whether or not the physician had provided medical services the previous night.”
Until now, most studies of the effect of sleep deprivation and fatigue on physician performance have focused on medical trainees.
They found that sleep deprivation may affect mood, cognition and “psychomotor function” and have led to duty-hour restrictions in all North American residency training programs.
That’s at odds with the findings of the new study, but its authors suggest some possible explanations for that.
“Attending physicians have greater experience than trainees, which may compensate for decrements in performance so that clinical outcomes are not affected,” the study says.
“More important, attending physicians may exercise professional judgment and self-regulate their practice the next day by cancelling surgeries or arranging for coverage by colleagues if they feel too fatigued to perform surgery safely.”
Though the study acknowledges that sleep deprivation and fatigue may affect physician performance, its findings suggest that calls for broad-based policy shifts in duty hours and the practices of attending surgeons “may not be necessary at this time,” the researchers say.
“However, the effect of profound sleep loss may warrant further study, and it remains important for physicians to critically assess the effects of all sources of fatigue on their individual ability to treat patients and self-regulate their practices appropriately.”