Surgeons' Outcomes Not Impacted When They Operate the Night Before

By Linda Carroll

May 25, 2022

NEW YORK (Reuters Health) - When surgeons operate overnight, it does not appear to impact their surgeries the next day, according to a new study.

Analyzing data from nearly 500,000 daytime operations performed by more than 1,100 surgeons, researchers found the incidence of morbidity and mortality in daytime surgeries when a doctor had operated overnight was within 0.02% of the incidence of those performed with no operations the night before.

"The main message of our study is that the practice of having surgeons work overnight and then continuing to operate the next day - as currently practiced at numerous medical centers - is safe for patients," said Dr. Eric Sun of the Stanford University School of Medicine, in California.

He and his colleagues were a little surprised, "since one might imagine that working overnight might impact a surgeon's performance the next day," Dr. Sun told Reuters Health by email. "Although we did not study this I think one aspect of our results is that institutions and surgeons themselves may take measures to mitigate the potential risks of working overnight and then continuing to operate the next day."

Such measures could include giving the surgeon who operated overnight an easier schedule the day after or giving her more help, such as another attending surgeon or a senior resident to assist, Dr. Sun said.

For their study, published in JAMA Internal Medicine, the researchers examined data from the Multicenter Perioperative Outcomes Group (MPOG), a registry of all surgical and diagnostic procedures requiring anesthesia care from more than 50 hospitals across 18 states and two countries (the U.S. and the Netherlands). MPOG includes all of a given surgeon's operations that were performed at the reporting institution.

Included in the analysis were data from more than 498,000 daytime procedures involving 1,131 unique surgeons. In 13,098 cases (2.6%), the attending surgeon operated between 11 PM and 7 AM the previous night. The mean patient age was 55 and just over half were male.

Once the researchers adjusted for operation type, surgeon fixed effects, and observable patient characteristics such as age and comorbidities, the incidence of in-hospital death or major complications was 5.89% among daytime operations when the attending surgeon operated the night before as compared with 5.87% among daytime operations when the same surgeon did not, a non-significant difference.

Except for operation length, the researchers did not find any significant associations between overnight work and secondary outcomes either. Operating the previous night was associated with a slight decrease in length of daytime operations (adjusted length, 112.7 vs. 117.4 minutes), a difference the researchers felt was "unlikely to be meaningful."

The new report "is a well-done study examining the potential effects of fatigue on a surgeon's performance," said Dr. Katherine Fischkoff, an associate professor of surgery and critical care at Columbia University Vagelos College of Physicians and Surgeons in New York City. "The study is large and covers gaps and potential limitations from smaller studies previously done."

"This study substantiates prior findings that that operating the night before does not have an impact on a surgeon's performance," Dr. Fischkoff, who was not involved in the study, told Reuters Health by email. "However, doubts may linger about why fatigue does not impact a surgeon's performance the way it has been shown to impact other high-intensity professions. Moreover, there may be other effects on surgeons, both short-term and cumulative, from working long and unpredictable hours."

SOURCE: https://bit.ly/3wBqSwT and https://bit.ly/3wEtQ3B JAMA Internal Medicine, online May 23, 2022.

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