Can acute care surgeons perform while fatigued? An EAST multicenter study

Schuster, Kevin M.; Hazelton, Joshua P.; Rattigan, Deviney; Nguyen, Linh; Kim, Dennis; Spence, Lara H.; Turay, David; Luo-Owen, Xian; Perez, Javier Martin; Dayal, Saraswati; Blatt, Melissa; Hill, C; Bhattacharya, Bishwajit

doi:10.1097/ta.0000000000001975

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…In another study, approximately 600 cases have roughly similar results, in regard to mortality and morbidity outcomes of the surgeries that been performed by fatigued and non-fatigued surgeons. However, the nub of the argument, is that rested surgeons who were more likely to perform on older or female patients, they concluded that the outcomes were similar for fatigued and rested surgeons, [ 9 ] which we think brought the same debate back to surface.…”

Section: Discussionmentioning

confidence: 99%

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Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh

et al. 2020

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As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform. A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 am to 3:59 pm , 4 pm to 11:59 pm , and midnight to 7:59 am . Participants’ mean age was 31.4 (standard deviation ± 13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P -value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries. This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.

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Section: Discussionmentioning

confidence: 99%

“…[ 8 ] Other studies concluded that the outcomes were similar for fatigued and rested surgeons. [ 9 ]…”

Section: Introductionmentioning

confidence: 99%

Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh

et al. 2020

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“…This study compared outcomes for complex emergency surgery cases between fatigued surgeons (no sleep in the prior 18 h) and non-fatigued surgeons (slept at least 3 out of the last 6 h). There was no difference in mortality or post-operative complications between the two groups [ 5 ]. Although patient outcomes may be unaffected, more work hours per week, fewer awake hours at home, and number of call shifts per week have been associated with poor physician work-life balance and burnout among trauma surgeons [ 2 , 3 ].…”

Section: Physical Wellnessmentioning

confidence: 99%

Environmental Factors Impacting Wellness in the Trauma Provider

2022

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Purpose of Review The purpose of this review is to evaluate the recent literature on environmental factors impacting wellness for the acute care surgeon. This includes factors influencing physical, mental, and emotional well-being. Recent Findings Recent studies have identified challenges to surgeon wellness including increased incidence of sleep deprivation, musculoskeletal pain and injuries, pregnancy complications, moral injury, posttraumatic stress disorder (PTSD), and burnout. Qualitative studies have characterized the surgeon’s emotional response to occupational stress, adverse events, and surgical complications. Further descriptive studies offer interventions to prevent moral injury after adverse events and to improve surgeon work environment. Summary Acute care surgeons are at increased risk of sleep deprivation, musculoskeletal pain and injury, pregnancy complications, moral injury, PTSD, and burnout. Surgeons experience feelings of isolation and personal devaluation after adverse events or complications, and this may lead to practice limitation and progression to PTSD and/or burnout. Interventions to provide mentorship, peer support, and education may help surgeons recover after adverse events. Further study is necessary to evaluate institution-driven interventional opportunities to improve surgeon well-being and to foster an inclusive and supportive environment.

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“…dures being performed, all operations were classified on an ordinal scale of complexity from 1 to 4. 20 Case complexity was assigned independently by 2 surgeons (K.M.S. and B.B.)…”

Section: Key Pointsmentioning

confidence: 99%

“…We hypothesized that outcomes may be improved with increased surgeon experience and undertook this secondary analysis of a previously reported cohort study. 20…”

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confidence: 99%

Association of Acute Care Surgeon Experience With Emergency Surgery Patient Outcomes and Mortality

et al. 2021

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IMPORTANCE Previous studies comparing emergency surgery outcomes with surgeon experience have been small or used administrative databases without controlling for patient physiology or operative complexity.OBJECTIVE To evaluate the association of acute care surgeon experience with patient morbidity and mortality after emergency surgical procedures. DESIGN, SETTING, AND PARTICIPANTSThis cohort study evaluated the association of surgeon experience with emergency surgery outcomes at 5 US academic level 1 trauma centers where the same surgeons provided emergency general surgical care. A total of 772 patients who presented with a traumatic injury and required an emergency surgical procedure or who presented with or developed a condition requiring an emergency general surgical intervention were operated on by 1 of 56 acute care surgeons. Surgeon groups were divided by experience of less than 6 years (early career), 6 to 10 years (early midcareer), 11 to 30 years (late midcareer), and 30 years or more (late career) from the end of training. Surgeons with less than 3 years of experience were also compared with the entire cohort. Hierarchical logistic regression models were constructed controlling for Emergency Surgery Score, case complexity, preoperative transfusion, and trauma or emergency general surgery. Data were collected from May 2015 to July 2017 and analyzed from February to May 2020.MAIN OUTCOMES AND MEASURES Mortality, complications, length of stay, blood loss, and unplanned return to the operating room. RESULTSOf 772 included patients, 469 (60.8%) were male, and the mean (SD) age was 50.1 (20.0) years. Of 772 operations, 618 were by surgeons with less than 10 years of experience. Early-and late-midcareer surgeons generally operated on older patients and patients with more septic shock, acute kidney failure, and higher Emergency Surgery Scores. Patient mortality, complications, postoperative transfusion, organ-space surgical site infection, and length of stay were similar between surgeon groups. Patients operated on by early-career surgeons had higher rates of unplanned return to the operating room compared with those operated on by early-midcareer surgeons (odds ratio [OR], 0.66; 95% CI, 0.40-1.09), late-midcareer surgeons (OR, 0.34; 95% CI, 0.13-0.90), and late-career surgeons (OR, 1.11; 95% CI,. Patients operated on by surgeons with less than 3 years of experience had similar mortality compared with the rest of the cohort (OR, 1.97; 95% CI, 0.85-4.57) but higher rates of complications (OR, 2.07; 95% CI, 1.05-4.07). CONCLUSIONS AND RELEVANCEIn this study, experienced surgeons generally operated on older patients with more septic shock and kidney failure without affecting risk-adjusted mortality. Increased complications and unplanned return to the operating room may improve with experience. Early-career surgeons' outcomes may be improved if they are supported while experience is garnered.

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Can acute care surgeons perform while fatigued? An EAST multicenter study

Abstract: Prognostic study, level IV.

Cited by 9 publications

References 16 publications

Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh

Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh

Environmental Factors Impacting Wellness in the Trauma Provider

Association of Acute Care Surgeon Experience With Emergency Surgery Patient Outcomes and Mortality

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