Surgeon Fatigue: Impact of Case Order on Perioperative Parameters and Patient Outcomes

Bagrodia, Aditya; Rachakonda, Varun; Delafuente, Karen; Toombs, Suzette; Yeh, Owen; Scales, Joseph; Roehrborn, Claus G.; Lotan, Yair

doi:10.1016/j.juro.2012.06.021

Cited by 18 publications

(11 citation statements)

References 24 publications

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“…These results are consistent with what was found in the previous studies [ 6 , 9 ]. However, they are very different from those of Bagrodia et al [ 24 ] and Uchal et al [ 5 ], who detailed that fatigue and performance are covariates. Increase in errors and time to complete laparoscopic task is more likely to be caused by trainee during acclimatization; however, as more and more trials are performed, the learning curve increases, which gradually decreases errors and completion time.…”

Section: Discussioncontrasting

confidence: 79%

Effects of Fatigue Based on Electroencephalography Signal during Laparoscopic Surgical Simulation

Ndaro

Wang

2018

Minimally Invasive Surgery

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Background Following recent advances in technology, there is a growing interest in studying fatigue based on electrophysiological signals as a means of monitoring brain activity. While some existing works relate fatigue to performance, others consider the two as independent entities. Therefore, we must explore this intricate issue, particularly in laparoscopic training, for the sake of patient safety. Objective This paper explores and evaluates effects of fatigue on efficiency and accuracy based on laparoscopic surgical training using Electroencephalography (EEG) signal. Materials and Methods 20 college students performed peg transfer task on laparoscopic simulator, with real-time recording of EEG signals for each subject. To monitor degree of fatigue, a real-time fatigue monitoring system based on fatigue analysis algorithm was designed through the use of EEG in alpha (α) and theta (θ) rhythms. We designed data acquisition and fatigue analysis modules based on MATLAB platform. BrainLink was used to record EEG signals and send them to personal computer wirelessly via Bluetooth. While artifacts from the captured EEG signals were removed using Blind Source Separation (BSS), α and θ rhythms were extracted using wavelet analysis. Fatigue was evaluated based on Regression Model and Mahalanobis Distance (DC), and its threshold was determined from the experimental results using Receiver Operating Characteristic (ROC) curve analysis. Results Completion time and number of errors behaved like a decreasing function during the first few trials while increasing afterwards with the increasing of perceived fatigue level. The results indicate that learning curve of the subjects is increasing until 13th trials when they have attained maximum learning benefits and decreases afterwards due to fatigue. Conclusion Regression analysis shows that there are significant learning and fatigue effects when peg transfer task in the training is repeated in a series of trials. However, for the training to be effective and efficient, there should be monitoring during the training to observe where in the learning curve a trainee gains maximum learning benefits. Furthermore, fatigue is a significant indicator of efficiency and accuracy in terms of completion time and errors, respectively.

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Section: Discussioncontrasting

confidence: 79%

Effects of Fatigue Based on Electroencephalography Signal during Laparoscopic Surgical Simulation

Ndaro

Wang

2018

Minimally Invasive Surgery

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“…It may be attributed to physicians fatigue after several hours' work. However, other studies revealed that whether the surgeons had performed other surgeries prior to complex liver resection [8] or prostatectomy [18] in the same day did not affect the perioperative outcome.…”

Section: Discussionmentioning

confidence: 95%

Impact of surgeon work duration prior to distal pancreatectomy on perioperative outcomes: a propensity score matching analysis

Wan

Wang

et al. 2021

BMC Surg

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Background Surgeons are likely to get progressively fatigued during the course of a normal workday. The objective of this study was to evaluate the impact of surgeon work duration prior to performing distal pancreatectomy (DP) on the perioperative outcome, especially frequency of grade II or higher grade postoperative complications. Methods Patients undergoing DP for all causes were divided into two groups according to surgeon work hours prior to performing DP: group A (less than 5 h) and group B (5–10 h). Propensity score matching (PSM) analysis (1:1) were performed to balance the baseline characteristics between the two groups. Intraoperative complications were compared between the two groups. Postoperative complications and their severity were followed up for 60 days and mortality for 90 days. The study was powdered to identify a 15% difference in the incidence of grade II or higher grade complications. Results By using PSM analysis, the patients in group A (N = 202) and group B (N = 202) were well matched regarding demographics, comorbidities, operative technique, pancreatic texture and pathology. There was no significant difference in the incidence of grade II or higher grade complications between the two groups. There was no difference in clinically relevant postoperative pancreatic fistula, percutaneous drainage, readmission, reoperation, or morality. Group B was associated with a higher incidence of intraoperative organ injury, which could be managed successfully during the operation. Conclusion The retrospective study demonstrated that the surgeon work duration did not significantly affect the clinical outcome of DP.

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“…As the attending always exclusively performed the first case of the day due to operative room availability, our results may have been subject to the potentially confounding effect of surgeon fatigue. Bagrodia et al 18 showed that operative times, intraoperative complications, and oncological and functional outcomes were similar regardless of order of RARP. However, the authors only compared outcomes between the first and second RARP cases of each day, and so the implications of surgeon fatigue on five consecutive RARPs (our typical operative day) is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Can robot-assisted radical prostatectomy be taught to chief residents and fellows without affecting operative outcomes?

Lee

Lightfoot

Mucksavage

et al. 2015

Prostate International

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PurposeTo determine whether robot-assisted radical prostatectomy (RARP) may be taught to chief residents and fellows without influencing operative outcomes.MethodsBetween August 2011 and June 2012, 388 patients underwent RARP by a single primary surgeon (DIL) at our institution. Our teaching algorithm divides RARP into five stages, and each trainee progresses through the stages in a sequential manner. Statistical analysis was conducted after grouping the cohort according to the surgeons operating the robotic console: attending only (n = 91), attending and fellow (n = 152), and attending and chief resident (n = 145). Approximately normal variables were compared utilizing one-way analysis of variance, and categorical variables were compared utilizing two-tailed χ2 test; P < 0.05 was considered statistically significant.ResultsThere was no difference in mean age (P = 0.590), body mass index (P = 0.339), preoperative SHIM (Sexual Health Inventory for Men) score (P = 0.084), preoperative AUASS (American Urologic Association Symptom Score) (P = 0.086), preoperative prostate-specific antigen (P = 0.258), clinical and pathological stage (P = 0.766 and P = 0.699, respectively), and preoperative and postoperative Gleason score (P = 0.775 and P = 0.870, respectively). Operative outcomes such as mean estimated blood loss (P = 0.807) and length of stay (P = 0.494) were similar. There was a difference in mean operative time (P < 0.001; attending only = 89.3 min, attending and fellow 125.4 min, and attending and chief resident 126.9 min). Functional outcomes at 3 months and 1 year postoperatively such as urinary continence rate (P = 0.977 and P = 0.720, respectively), and SHIM score (P = 0.661 and P = 0.890, respectively) were similar. The rate of positive surgical margins (P = 0.058) was similar.ConclusionsTraining chief residents and fellows to perform RARP may be associated with increased operative times, but does not compromise short-term functional and oncological outcomes.

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Surgeon Fatigue: Impact of Case Order on Perioperative Parameters and Patient Outcomes

Abstract: Despite concern that surgeon fatigue may impact outcomes, our data suggests that performing several complex urological procedures consecutively is not associated with worse outcomes.

Cited by 18 publications

References 24 publications

Effects of Fatigue Based on Electroencephalography Signal during Laparoscopic Surgical Simulation

Effects of Fatigue Based on Electroencephalography Signal during Laparoscopic Surgical Simulation

Impact of surgeon work duration prior to distal pancreatectomy on perioperative outcomes: a propensity score matching analysis

Can robot-assisted radical prostatectomy be taught to chief residents and fellows without affecting operative outcomes?

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