Sleepy surgeons still safe

Leaving your heart in the hands of a sleepy surgeon may sound terrifying, but according to a Canadian study there is little to worry about.

Over six years, patients at London Health Sciences Centre in Ontario fared equally well when their surgeons were well-rested as when they were operating on fewer than three hours of sleep, said the study, reported in the Archives of Surgery.

“This is certainly reassuring to the public,” said Michael Chu, a heart surgeon at the center who worked on the study.

“They don’t have to worry about surgeons being sleep deprived.”

The findings add to a long-standing debate over the safety of trusting red-eyed doctors with life-and-death operations that require quick thinking and lots of dexterity.

While studies have shown that a lack of sleep leads to a drop in both mental and manual skills, it has not been clear how that affects performance in the operating room.

But the recent study hasn’t convinced all experts.

“I don’t think this is necessarily reassuring. There is a reason why pilots don’t fly if they didn’t sleep the night before,” said Jeffrey Rothschild, of Brigham and Women’s Hospital in Boston.

Rothschild and colleagues, in a 2009 study of more than 200 doctors, found that the number of complications nearly doubled when surgeons operated after fewer than six hours of sleep.

The Canadian study, by contrast, followed only six heart surgeons with a total of 4000 surgeries over six years.

About 40 percent of the time, the surgeon said they’d slept between three and six hours. Two percent of the time, they’d gotten fewer than three hours of sleep.

During the surgeries, 3,6 percent of the patients died when the surgeons had slept no more than three hours, compared to 2,8 percent when they’d had three to six hours and 3,4 percent when they’d rested longer.

Those small differences may have been due to chance, Chu and his colleagues reported.

Major complications such as stroke or kidney failure occurred in 15 percent of the cases when surgeons had slept for fewer than six hours and 17 percent when they’d slept more.

“We feel comfortable continuing on with our practice the way it is, knowing that patient safety is not compromised,” Chu told Reuters Health.

He said teamwork and long hours of training with little sleep might explain why heart surgeons appear to cope well with a lack of downtime.

But Kanav Kahol, who has studied sleep deprivation at Banner Good Samaritan Medical Center in Phoenix, Arizona, warned that the results should be interpreted cautiously.

“It is well known from research, including ours, that the impact on clinical outcomes of sleep deprivation is a function of experience and speciality,” he told Reuters Health by email.

“Residents do make more errors in sleep deprived conditions than attending (physicians), and while neurosurgeons don’t seem to be impacted with fatigue, general surgeons do.”

Several countries, including the US, recently put limits on the maximum duty hours and on-call time for resident doctors in an attempt to improve patient safety — a step that Chu worried might backfire.

“Perhaps we are conditioned to be able to perform better under these circumstances. The rigidity of the new rules could potentially be sacrificing patient safety in the future,” he added.

But Rothschild disagreed.

“I don’t agree that you get a baked-in skill set by operating on no sleep. It is a real leap to make that statement,” he said.