Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill

Eastridge, Brian J.; Hamilton, Elizabeth C.; O’Keefe, Grant E.; Rege, Robert V.; Valentine, R. James; Jones, Daniel; Tesfay, Seifu T.; Thal, Erwin R.

doi:10.1016/s0002-9610(03)00183-1

Cited by 266 publications

(180 citation statements)

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“…20 Improved manual dexterity from being better rested could account for the former finding, consistent with prior simulation studies. [87][88][89] The latter finding of more conversions to open procedures could reflect the impact of less resident experience with laparoscopy in the post-2003 time period. Less continuity of care may also contribute to certain complications.…”

Section: Discussionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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), bibliographies, pertinent reviews, and meeting abstracts. STUDY SELECTION: We included studies examining the relationship between the pre-and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies. DATA EXTRACTION: One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality. RESULTS: Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Metaanalysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I 2 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies. LIMITATIONS: Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible. CONCLUSIONS:Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.

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Section: Discussionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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“…[12] They reported that following SD, more surgical errors were made in all of the 6 tasks studied, and there was a slight, but not significant, prolongation of time required to complete the tasks. Taffinder et al also used a laparoscopy simulator and evaluated 6 residents and response to SD; they also found decreased dexterity using the simulator following SD.…”

Section: Discussionmentioning

confidence: 95%

Effect of sleep deprivation on finger dexterity in resident doctors

Hirkani¹,

Yogi²

2017

Natl J Physiol Pharm Pharmacol

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Background: Prolonged resident duty hours may affect patient care. There are no restrictions to the amount of hours a resident can work which may lead to medical errors and lapses in patient care. Aims and Objectives: The purpose of this study was to prospectively evaluate the effect of sleep deprivation (SD) on finger dexterity at different intervals of SD during the residents' on-call period and to identify the duration after which these effects begin. We further tested if this decline correlated with the subjective assessment of sleepiness. Materials and Methods: The finger dexterity was measured by the O'Connor dexterity apparatus, and subjective sleepiness assessment was carried out using pictorial sleepiness scale in 30 resident doctors at 6 h intervals during their on-call period which lasted for 24 h. Results: The finger dexterity was significantly decreased at the end of the 24 h duty period as compared to the baseline. This deterioration began after being on-call for 12 h and progressed thereafter. The changes in finger dexterity correlated negatively with the subjective sleepiness assessment. Conclusion: 24 h of SD during on-call duty significantly decreases the finger dexterity in resident doctors. This might be a major cause of medical errors and hamper patient safety.

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“…It is likely that the difficulty experienced by fatigued residents on tubes is due to a decrease in the fine motor skills required for this challenging exercise. 6 Studies on the learning curve for robotic assisted laparoscopic radical prostatectomy show the vesicourethral anastomosis to be one of the more difficult steps for the novice robotic surgeon in vivo. 19 Recreation of this skill set on a virtual platform with the Tubes exercise is likewise challenging and is impacted by fatigue.…”

Section: Discussionmentioning

confidence: 99%

“…3 This observation has been supported with subsequent studies post duty hours restrictions showing deficiencies in psychomotor and cognitive skills in tired surgical trainees. 4,5,6,7 However, like with many simulation-based training regimens, we are somewhat behind when compared to other fields. The effects of fatigue on performance has long been studied and established, and in fact in aviation, simulation is being used to mimic fatigue and help develop strategies to mitigate its effects on performance.…”

Section: Introductionmentioning

confidence: 99%