Impact of sleep deficiency on surgical performance: a prospective assessment.

STUDY OBJECTIVES: Sleep deficiency can adversely affect the performance of resident physicians, resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons, is less clear. METHODS: Sixty attending surgeons from academic and community departments of surgery or obstetrics and gynecology were studied prospectively using direct observation and self-report to explore the effect of sleep deprivation on patient safety, operating room communication, medical errors, and adverse events while operating under 2 conditions, post-call (defined as > 2 hours of nighttime clinical duties) and non-post-call. RESULTS: Each surgeon contributed up to 5 surgical procedures post-call and non-post-call, yielding 362 cases total (150 post-call and 210 non-post-call). Most common were caesarian section and herniorrhaphy. Hours of sleep on the night before the operative procedure were significantly less post-call (4.98 ± 1.41) vs non-post-call (6.68 ± 0.88, P < .01). Errors were infrequent and not related to hours of sleep or post-call status. However, Non-Technical Skills for Surgeons ratings demonstrated poorer performance while post-call for situational awareness, decision-making, and communication/teamwork. Fewer hours of sleep also were related to lower ratings for situational awareness and decision-making. Decreased self-reported alertness was observed to be associated with increased procedure time. CONCLUSIONS: Sleep deficiency in attending surgeons was not associated with greater errors during procedures performed during the next day. However, procedure time was increased, suggesting that surgeons were able to compensate for sleep loss by working more slowly. Ratings on nontechnical surgical skills were adversely affected by sleep deficiency. CITATION: Quan SF, Landrigan CP, Barger LK, et al. Impact of sleep deficiency on surgical performance: a prospective assessment. J Clin Sleep Med. 2023;19(4):673-683.

The effect of physician sleep deprivation on patient safety in perinatal-neonatal medicine.

Recent data indicate that as many as 180,000 patients die each year due to harm suffered as a result of medical care. Between 40 and 60% of these deaths-and the millions of injuries due to medical care-are preventable. In the neonatal intensive care unit (NICU), neonates' size and fragility makes them especially susceptible to serious medical errors, which occur at a far higher rate in this population than elsewhere in hospitals. A growing body of literature demonstrates that the work schedules and sleep deprivation of physicians are important contributors to this epidemic of error. Nowhere is there a higher risk of adverse outcomes due to provider sleep deprivation than in the NICU, where even minor lapses of attention or miscalculations can lead to dire patient outcomes. This review will discuss what is known about how provider sleep deprivation may impact perinatal and neonatal medicine and will discuss ongoing research questions that must be addressed to guide future improvement efforts.