How well do surgeons operate after overnight work? Study suggests sleep deprivation doesn’t affect surgery

TORONTO – If your surgeon looks at you with tired eyes, are you worried about putting your health in his or her hands in the operating room? New research may give you some relief: a Canadian study that looked at daytime operations after some surgeons were called in overnight suggests that the sleep interruption didn’t affect their focus the next day.

There’s been heavy debate around the world about how many hours medical and surgical residents should be working each week. Some regions have even created restrictions keeping doctors in training from working more than 60 or so hours a week. And there’s even been a push for graduated doctors to comply to similar rules.

In a new study, surgeon and lead author Dr. Chris Vinden sought to look at how sleep deprivation could affect surgeons compared to how they fared without any overnight interruptions.

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Surgeons, like Vinden, are on call, sometimes a few times a week and could get called to work between midnight and 7 a.m. for emergency operations. By day, they’re still on the job for scheduled surgeries.

In his study, Vinden looked at 94,183 gall bladder surgeries – called laparoscopic cholecystectomies – performed by surgeons in Ontario between 2004 and 2011.

He chose this procedure because it’s the most common surgery in Ontario and likely around the world, Vinden told Global News.

“We know that driving home is a mundane thing and we know doctors driving home after they’ve been on call have higher accident rates, but the question is: is surgery that boring that we can make mistakes?” Vinden said.

“This study shows that even basic surgery is complex enough that you can overcome the hurdle. Even a simple operation is quite challenging and you have to concentrate,” he said.

Vinden is a surgeon at London Health Sciences Centre and associate professor of surgery at Western University.

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The Institute for Clinical Evaluative Sciences study was published Tuesday in the Journal of the American Medical Association.

About 331 surgeons from 102 hospitals were included in the study that analyzed an Ontario database. The surgeons were all called in for emergency operation at some point in time. The study was able to indicate when the scheduled daytime operations were done by a surgeon who was forced out of bed at night.

Turns out, 2,078 gall bladder surgeries – roughly one in five – were done by surgeons who were on call the night before. Still, there was no difference in the success of the surgeries even if doctors may have been sleep deprived.

“The study failed to show any signal of an effect,” Vinden said, noting that the cohort information stems from one of the largest databases in the world.

Surgeons could get pulled away from bedtime if they’re on call for hours at a time. For example, if a patient needs emergency care, the surgeon could be in the operating room from 2 a.m. until 5 a.m. and then head home.

If he or she works in a busier department, say, neo-natal care, then they could be even busier, Vinden said.

Right now, Quebec is the only Canadian province with stringent rules that prohibit medical trainees from working shifts longer than 16 hours.

There are no work hour restrictions on physicians in Canada. But moving in that direction could come with some repercussions, Vinden warns.

Patients could be handed over to another surgeon who didn’t initially treat them, his or her surgeon may not be in the next day if complications come up and in smaller communities, staffing problems could lead to surgery cancellations or delays.

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“It’d be a very complex and expensive thing to do. It likely doesn’t make a lot of sense,” Vinden said.

Last June, the Royal College of Physicians and Surgeons of Canada, along with nine other organizations, put together its report on medical residents.

It didn’t outright say how many hours doctors and trainees should be working. Instead, it focused on managing physician fatigue, Dr. Ken Harris told Global News.

“What we really need to talk about is fatigue management. We need to know when we’re not safe to go about our daily business,” Harris said.

Harris is a surgeon with 25 years of experience and executive director of specialty education at the Royal College.

“We need to teach individuals how to manage their fatigue so they wouldn’t put themselves in situation that’s dangerous for patients and for them,” he said.

carmen.chai@globalnews.ca
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