Noticias

Noticias

  • Título: Surgeons’ sleep deprivation may not adversely impact performance, by Dr. Frank Criado
  • Fecha: 28-12-2015

  • Frank J Criado, MD, FACS, FSVM

    In a recent study (published online Aug 26, 2015), attending surgeons who work through the wee hours of the night do not have measurably different short-term outcomes for elective surgical operations performed the next day. The primary composite outcome of death, readmission, or complications within 30 days occurred in 22.2% of patients undergoing daytime surgery by an attending who treated patients from midnight to 7 a.m. and in 22.4% of those undergoing the same procedure by the same attending, but after a night when no clinical work had been performed (P = .66). There was no significant difference between the groups in the primary outcome in adjusted analyses.

    Secondary outcomes also were similar between the post-midnight and control groups: death within 30 days (both 1.1%), readmission within 30 days (6.6% vs. 7.1%), complications within 30 days (18.1% vs. 18.2%), median length of stay (both 3 days), and median duration of surgery (both 2.6 hours). “These data suggest that calls for broad-based policy shifts in duty hours and practices of attending surgeons may not be necessary at this time,” wrote Anand Govindarajan et al. (N Engl J Med. 2015;373:845-53. doi: 10.1056/NEJMsa1415994).

    Most studies of physicians suggesting that sleep deprivation may affect mood, cognition, and psycho-motor function have focused on medical trainees, but few studies have examined the effects of sleep deprivation in attending physicians and the results have been conflicting. A 2009 single-center study prompted calls for policy-level changes regarding sleep deprivation in surgeons after showing a higher rate of complications for procedures performed by attending physicians with sleep opportunities of less than 6 hours (JAMA 2009;302:1565-72), but the findings have not been replicated by others.

    The current study involved 38,978 patients who underwent 1 of 12 elective daytime procedures performed by 1,448 physicians at 147 hospitals in Ontario, Canada. Patients undergoing procedures performed by a physician who had treated patients from midnight to 7 a.m. were matched in a 1:1 ratio to patients undergoing the same procedure by the same physician on a day when the physician had not treated patients after midnight. The physicians had been in practice for a median of 20 years, and 40.6%

    of procedures were performed at academic institutions. Physicians who treated patients after midnight performed a mean of 1.25 procedures during that time. The elective procedures (cholecystectomy, gastric bypass, colon resection, coronary artery bypass grafting, coronary angioplasty, knee replacement, hip replacement, hip fracture repair, hysterectomy, spinal surgery, craniotomy, and lung resection) were all performed on weekdays. “The broad scope of the study enhances its generalizability, a particularly relevant consideration if policy changes are being contemplated with respect to duty hours,” Dr. Govindarajan and his associates noted.



  • Fuente: endovascular.es