When I was a resident, there were any number of times when I worked for 36 hours straight. I’d get to work around 6 or 7, work all day, then all night, and then stay on until late the next afternoon. I wasn’t just pushing paper, either. Lots of these times I was covering things like the infant intensive care unit, and performing procedures in the middle of the night or after having not slept.
I always worried that the quality of my care would suffer. I know the quality of my person, did. That’s why I was so interested in this study in the NEJM. “Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work“:
BACKGROUND: Sleep loss in attending physicians has an unclear effect on patient outcomes. In this study, we examined the effect of medical care provided by physicians after midnight on the outcomes of their scheduled elective procedures performed during the day.
METHODS: We conducted a population-based, retrospective, matched-cohort study in Ontario, Canada. Patients undergoing 1 of 12 elective daytime procedures performed by a physician who had treated patients from midnight to 7 a.m. were matched in a 1:1 ratio to patients undergoing the same procedure by the same physician on a day when the physician had not treated patients after midnight. Outcomes included death, readmission, complications, length of stay, and procedure duration. We used generalized estimating equations to compare outcomes between patient groups.
Researchers in Canada created a cohort of patients operated on by physicians who either did or did not treat patients between the hours of midnight and 7 AM the night before. They matched patients who underwent the same procedure by the same physician on a day when that doc had worked at night or not. They looked at the rates of death, readmissions, complications, procedure duration, and length of stay.
There were almost 40,000 patients in this study, treated by almost 1450 surgeons. About 41% of the procedures occurred at an academic center.
There were no significant differences in the adjusted rates of death (1.1% in both groups), readmissions (6.6% vs 7.1%), or complications (18.1% vs 18.2%) between the two groups. The median length of stay was 3 days, and, again, there were no differences between groups. The median duration of surgery was 2.6 hours, and the interquartile ranges were almost identical – no significant differences there either.
It’s possible that the previous studies showing differences in care between those who are more and less sleep deprived may have focused on trainees, versus attending physicians, and that the latter are better. It’s also possible that the surgeons exercise better judgement and recuse themselves when they are potentially a danger to patients. It’s also possible that surgeons are different from the rest of us. Or, maybe I just need sleep more than they do.
Regardless, this study provides a nice data point showing that surgeons caring for patients in the middle of the night don’t appear to be putting their patients at significant risk. That’s good news for everyone.