What, me sleep? Sleepless doctors perform well in OR

doctorssleeporSome doctors can do a surgery in their sleep, and others do a surgery when they should be asleep. In the latter case, though, when a surgeon performs a late night surgery and then a daytime operation after little or no sleep, the rate of readmissions, complications, and death is pretty much the same as if the doctor had had a good night’s sleep. According to a study published in the New England Journal of Medicine, 22.2% of patients who underwent a surgical procedure after their doctor worked the midnight shift encountered complications – compared to 22.4% who had the same surgeon perform the same procedure when said surgeon had had the night off.

The University of Toronto and Mount Sinai Hospital researchers researched health and billing databases in the entire Canadian province for 40,000 patients who had had a coronary-artery bypass grafting; spinal surgery; removal of the gall bladder, uterus or part of the lung or colon; gastric bypass; craniotomy; coronary angioplasty; knee or hip replacement; or repair of a fractured hip – all elective procedures. More than 19,000 patients were identified as having been operated on by 1,448 surgeons who had worked between 12 a.m. and 7 a.m. the same day – not counting early morning rounds. “Acute sleep deprivation can impair mood, cognitive performance, and psychomotor function,” the authors of the study wrote. But “we did not find any significant difference in outcomes.”


Post-midnight group


Control group


Days spent in the hospital













Moreover, whether the surgeon was young or old, or worked at an academic hospital or a private practice did not make any difference either. Both sleep and non-sleep groups took 2.6 hours on average to complete surgeries. The takeaway would seem to be that there is no need for work-hour limits. However, past president of the American College of Surgeons and chair of surgery at University of Washington Medicine in Seattle Dr. Carlos Pellegrini is concerned “that those who have been hounding this idea that we can spend all night operating and operate in the morning, don't take this paper as saying that you can do that and have the same outcomes.” Pellegrini agrees with the Sleep Research Society-endorsed legislation that requires doctors who have been up for 22 of the past 24 hours to let their patient know about it; he said that “if the person to be operated on is my wife or my son and I know that the surgeon has been up for a considerable time during the night and the operation is going to be a three- to four-hour operation, I will talk to that surgeon and say, 'Not today, wait until tomorrow.” He added that the “obligation of the surgeon is to look at how I can be in the best physical and mental shape, including lack of fatigue, to perform at my peak. You may make that decision to say, 'No, I'm not going to do this case in the morning because this may take me seven hours and I don't want to be six hours into it and realize I'm dead tired.'”

It is important to note too that the researchers do not actually support sleep deprivation either. “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,” they wrote. While senior study author and surgery division chief at St. Michael's Hospital in Toronto Dr. Nancy Baxter said that surgeons “seem to be doing a good job of” planning “around their schedules based on their individual ability to tolerate sleep deprivation,” she also remarked that “taking away the ability for physicians to self-regulate the work they do the day after being on call would really have the potential to cause harm. Sleep deprivation affects us all, and some people deal with it poorly and some deal with it well, and only the individual physician can really judge this.”


Related Read:

- Are you getting enough Sleep?