COMMENTARY

How Well Do Surgeons Perform With Lack of Sleep?

Albert B. Lowenfels, MD

Disclosures

February 13, 2014

Complications of Daytime Elective Laparoscopic Cholecystectomies Performed by Surgeons Who Operated the Night Before

Vinden C, Nash DM, Rangrej J, et al
JAMA. 2013;310:1837-1841

Summary

Does loss of sleep from unscheduled nocturnal surgery have a negative impact on subsequent daytime elective laparoscopic cholecystectomy? The authors used Canadian administrative data to compare the outcome in 2078 cholecystectomies performed by surgeons who operated the preceding night vs 8312 cholecystectomies performed by surgeons with no immediately antecedent nocturnal surgery. The patient characteristics of the 2 groups were nearly identical. The results after cholecystectomy were similar in the 2 groups: the relative risk for conversion to an open procedure was 1.18 (P = .33), iatrogenic injuries were insignificantly lower in the nocturnal surgery group, and overall mortality was low and similar in the 2 groups.

Viewpoint

In this study, about 20% of surgeons performing daytime laparoscopic surgery had a disruption of their normal sleep because of an emergency operation on the preceding night. On the basis of 3 measures of quality (ie, conversion to an open operation, iatrogenic injuries, and mortality), operating the night before surgery had no impact on patient outcome. The study results are similar to previous reports about cardiac and trauma surgery. An appreciable proportion of the general surgeon's work load concerns emergency surgery, often at night. This report is reassuring because the findings imply that sleep disruption on the night before a scheduled abdominal operation does not cause a measurable difference in the quality of surgery.

Abstract

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