• Study: Should you worry if your surgeon operated the night before?

    New in JAMA:

    Importance  The effect of surgeons’ disrupted sleep on patient outcomes is not clearly defined.

    Objective  To assess if surgeons operating the night before have more complications of elective surgery performed the next day.

    Design, Setting, and Participants  Population-based, matched, retrospective cohort study using administrative health care databases in Ontario, Canada (2012 population, 13 505 900). Participants were 2078 patients who underwent elective laparoscopic cholecystectomies performed by surgeons who operated the night before, matched with 4 other elective laparoscopic cholecystectomy recipients (n = 8312).

    Exposure  In total, 94 183 eligible elective laparoscopic cholecystectomies were performed between 2004 and 2011. Of these surgeries, there were 2078 procedures in which 331 different surgeons across 102 community hospitals had operated between midnight and 7 am the night before. Each “at-risk” surgery was randomly matched with 4 other elective laparoscopic cholecystectomies (n = 8312) performed by the same surgeon, who had no evidence of having operated the night before.

    Main Outcomes and Measures  The primary outcome was conversion from a laparoscopic cholecystectomy to open cholecystectomy. Secondary outcomes included evidence of iatrogenic injuries or death. Risks were quantified using generalized estimating equations.

    They found that there was no significant association in the rates at which laproscopic cholecystectomies had to be converted to open cholecystectomies related to whether surgeons operated the previous night. They also found no associations between operating the night before and iatrogenic injuries during surgery, or in deaths from surgery.

    In other words, this study found no evidence to support the idea that there are safety concerns with surgeons who operated the night before with respect to elective daytime cholecystectomies. Good news!


    • Yes, Dr. Carroll, there is some good news to be found here.

      Better news would be that informed consent for surgery would include information about the rested state of the surgeon. This is analogous to the driving/resting logs of long-haul truckers and the even more stringent rules for the rested state of airline pilots.

    • I can’t access the paper, so I can’t tell whether the authors address this, but…

      Is there an endogeneity problem here? Just thinking – if a surgeon is above-average, their services may be in higher demand, and thus they may be more likely to operate frequently, and therefore may be more likely to have operated more recently relative to the present operation than a surgeon who is below-average. That could essentially mean that even if lack of rest reduces surgical ability the effect may be balanced out by the higher quality of surgeons who have less rest.

      • I’m not sure if being called to operate at night has to do with surgical skill as much as with who is on call that particular night (which rotates).

    • Was there sufficient power to detect a difference? That should be ther first question asked after any ‘negative’ study. I’ll try to have a look at the paper and get back to you …