Acute care surgery performed by sleep deprived residents: are outcomes affected?

The Journal of Surgical Research
Arezou YaghoubianChristian de Virgilio

Abstract

The Institute of Medicine recently recommended further reductions in resident duty hours, including a 5-h rest time for on-call residents after 16 h of work. This recommendation was purportedly intended to better protect patients against fatigue-related errors made by physician trainees. Yet no data are available regarding outcomes of operations performed by surgical trainees working without rest beyond 16 h in the current 80-h workweek era. A retrospective review of all laparoscopic cholecystectomies (LC) and appendectomies performed by surgery residents at a public teaching hospital from July 2003 through March 2009. Operations after 10 PM were performed by residents who began their shift at 6 AM and had thus been working 16 or more hours. An outcomes comparison between time periods was conducted for operations performed between 6 AM and 10 PM (daytime) and 10 PM and 6 AM (nighttime). Outcome measures were rates of total complications, bile duct injury, conversion to open operation, length of surgery, and mortality. Over the 7-y study period, 2908 LC and 1726 appendectomies were performed. Appendectomies were performed laparoscopically in 73% of cases in patients for both time periods. There were no differences in rates of ov...Continue Reading

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