Outcomes of Operations Performed by Attending Surgeons after Overnight Trauma Shifts

Abstract

BACKGROUND To date, work-hour restrictions have not been imposed on attending surgeons in the United States. The purpose of this study was to investigate the impact of working an overnight trauma shift on outcomes of general surgery operations performed the next day by the post-call attending physician. STUDY DESIGN Consecutive patients over a 3.5-year period undergoing elective general surgical procedures were reviewed. Procedures were limited to hernia repairs (inguinal and ventral), cholecystectomies, and intestinal operations. Any operations that were performed the day after the attending surgeon had taken an overnight trauma shift were considered post-call (PC) cases; all other cases were considered nonpost-call (NP). Outcomes from the PC operations were compared with those from the NP operations. RESULTS There were 869 patients identified; 132 operations were performed PC and 737 were NP. The majority of operations included hernia repairs (46%), followed by cholecystectomies (35%), and intestinal procedures (19%). Overall, the PC operations did not differ from the NP operations with respect to complication rate (13.7% vs 13.5%, p = 0.93) or readmission within 30 days (5% vs 6%, p = 0.84). Additionally, multivariable logistic regression failed to identify an association between PC operations and the development of adverse outcomes. Follow-up was obtained for an average of 3 months. CONCLUSIONS Performance of general surgery operations the day after an overnight in-hospital trauma shift did not affect complication rates or readmission rates. At this time, there is no compelling evidence to mandate work-hour restrictions for attending general surgeons.

Middle-of-the-Night Percutaneous Coronary Intervention and its Association With Percutaneous Coronary Intervention Outcomes Performed the Following Day

“…Finally, no difference in readmission rates was observed among patients operated on by general surgeons after providing a trauma call (20). When considered alongside these data, our findings are was defined as beginning between midnight and 6:59 AM, whereas next-day PCI procedures included those which began between 7 AM and midnight on the same date.…”

Effects of sleep hours and fatigue on performance in laparoscopic surgery simulators

“…[11,12] Sharpe et al studied the effects of attending surgeons working the day after a night on call and found no difference in the complication or readmission rates. [13] One study that tested the effects of sleep deprivation on physicians and non-physicians reported less variation in performance in the physician group, possibly because those test subjects were “used to” performing with little sleep. [14] Further, studies have shown adaptation to sleep deprivation after three nights, which would explain why experienced surgeons who are presumably adapted to sleeplessness did not show a difference in performance with acute sleep deprivation.…”

Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work

“…4,5 The results of studies exploring clinical outcomes have been mixed, but a systematic review showed that a prolonged duration of sleeplessness, which would result from the provision of overnight medical care, significantly reduces clinical performance. [8][9][10][11][12] The published studies on this topic have had small samples and few events, resulting in limited statistical power. This literature has contributed to the current duty-hour restrictions mandated in all North American residency training programs.…”