Sleep deprivation does not affect operative results in cardiac surgery.
BACKGROUND
There has been an increasing trend towards the mandatory reduction in work hours for physicians because of the fear that sleep-deprived (SD) surgeons are more prone to make mistakes. We hypothesized that sleep deprivation would not be associated with increased morbidity or mortality in cardiac operations.


METHODS
A retrospective review was done of all cases performed by all attending cardiac surgeons from January 1994 to April 2003. Complication rates of cases performed by SD surgeons were compared with cases done when the surgeons were not sleep-deprived (NSD). A surgeon was deemed sleep deprived if he or she performed a case the previous evening that started between 10:00 pm and 5:00 am, or ended between the hours of 11:00 pm and 7:30 am.


RESULTS
A total of 6,751 cases were recorded in the Society of Thoracic Surgeons database over the 9-year period examined. Of these, 339 cases (5%) were performed by SD surgeons, and 6,412 (95%) cases were performed by NSD surgeons. Mortality rates for coronary artery bypass operations showed no significant differences (1.7% [SD = 4/223] vs 3.1% [NSD = 133/4206)] p = 0.34). Operative (p = 0.47), pulmonary (p = 0.60), renal (p = 0.93), neurologic (p = 0.11), and infectious (p = 0.87) complications of all cases also failed to show any statistically significant differences in any group. Perfusion times, cross-clamp times, and the use of blood products were also similar between groups.


CONCLUSIONS
Sleep deprivation does not affect operative morbidity or mortality in cardiac surgical operations. These data do not support a need for work hour restrictions on surgeons.
Ellman
Peter I
PI
Department of Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA.
Law
Marianna G
MG
Tache-Leon
Carlos
C
Reece
T Brett
TB
Maxey
Thomas S
TS
Peeler
Benjamin B
BB
Kern
John A
JA
Tribble
Curtis G
CG
Kron
Irving L
IL
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012892:Sleep Deprivation / Q000453:epidemiology*; D020178:Sleep Disorders, Circadian Rhythm / Q000453:epidemiology*; D015996:Survival Rate; D013903:Thoracic Surgery / Q000592:standards / Q000706:statistics & numerical data*; D014768:Virginia; D014940:Work Schedule Tolerance