New research from Brigham and Women’s Hospital (BWH) finds that procedures performed the day after attending physicians worked overnight were not more likely to have an increased risk for complications if the physician had an opportunity to sleep for six or more hours. If a physicians’ only opportunity for sleep was less than six hours, the risk for complications in a procedure following an overnight procedure rose significantly. The findings appear in the October 14, 2009 issue of JAMA.
The researchers compared 919 surgical procedures and 957 obstetrical procedures performed following an overnight emergency procedure with 3,552 similar surgical procedures and 3,945 similar obstetrical procedures performed by the same physicians on days without having performed overnight emergency procedures. The procedures in this study were performed between January 1999 and June 2008.
Overall, the researchers found that procedures performed the day after attending surgeons and obstetrician/gynecologists worked during the overnight did not increase the risk for complications in procedures the following day when compared with similar procedures performed that were not preceded by overnight work. However, the researchers found that among surgeons, a nearly 3-fold increase for risk of complications in procedures following an overnight procedure when the surgeon had less than a six hour opportunity for sleep (62 complications, 8.5 percent of procedures) compared to when the surgeon had a greater than six hour opportunity for sleep (6 complications, 3.1 percent of procedures).
Because performing an overnight procedure followed by additional procedures during the next day extends a doctors work hours, the researchers looked at complication rates among procedures done by physicians who worked less than 12 hour shifts and those who worked greater than 12 hour shifts. They found there were higher complication rates compared to the case done during the less than 12 hour work shift but the difference was not significant.
“Our findings suggest that attending physicians, like resident physicians and nurses, may be at an increased of making errors when sleep deprived or working extended shifts,” said Dr. Jeffrey Rothschild, lead author of the study and a physician in the Department of General Medicine and Primary Care at Brigham and Women’s Hospital. He added, “We are adding to the limited literature on the effects of attending physician sleep deprivation and extended work shifts on clinical outcomes for patients.”
He concluded, “It is important to note that the complication rates for the attending physicians who participated in our study who performed procedures the previous night was not higher than those who did not. But it was also clear that surgeons with limited opportunity for sleep had substantially higher complication rates compared to those with a longer opportunity to sleep.”
Dr. Jeffrey Rothschild will present the findings from this study at a JAMA press conference on Tuesday, October 13 at 10 a.m. Central time.
The study was funded by a grant from the Rx Foundation.