Fatigued surgeon performance has only been assessed in simulated sessions or retrospectively after a night on call. We hypothesized that objectively assessed fatigue of acute care surgeons affects patient outcome.
Five acute care surgery services prospectively identified emergency cases over 27 months. Emergency cases were defined by the surgeon identifying the patient as requiring immediate operation upon consultation or admission. Within 48 hours surgeons reported, sleep time accumulated prior to operation, if non-clinical delays to operation occurred and patient volume during the shift. To maximize differences, fatigued surgeons were defined as performing a case after midnight without having slept in the prior eighteen hours. Rested surgeons performed cases at or before 8 PM or after at least 3 hours of sleep prior to operation. A four-level ordinal scale was used to assign case complexity. Hierarchical logistic regression models were constructed to assess the impact of fatigue on mortality and major morbidity while controlling for center and patient level factors.
Of 882 cases collected 611 met criteria for fatigue or rested. Of these cases 370 were performed at night and 182 by a fatigued surgeon. Rested surgeons were more likely to be operating on an older or female patient, other characteristics were similar. Mortality and major morbidity were similar between fatigued and rested surgeons (12.1% vs. 12.1%) and (46.9% vs. 48.9%) respectively. After controlling for center and patient factors, surgeon fatigue did not impact mortality or major morbidity. Mortality variance was 6.30% and morbidity variance was 7.02% among centers.
Acute care surgeons have similar outcomes in a fatigued or rested state. Work schedules for acute care surgeons should not be adjusted to shifts less than 24 hours for the sole purpose of improving patient outcomes.
IV STUDY TYPE: Prognostic.
This research output has an Altmetric Attention Score of 47. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 February 2019.
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