title: The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial.
abstract: BACKGROUND
  To compare the impact of sleep deprivation after 24-hour duty (post-call) with that of 8-hour work (post-work) on product quality (PQ) and procedure effectiveness (PE) in a laparoscopic physical simulator.
  
  
  METHODS
  Voluntary surgeons and nurses were pretested with the Epworth Sleepiness Scale (ESS) and Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR). Surgical task was suturing perforated ulcer on a foam stomach in a physical simulator. PQ and PE were measured by accuracy error (AE), tissue damage (TD) leak rate (LR), goal- (GDA) non-goal-directed actions (NGDA), and operating time (OT), respectively. Construct validity was assessed comparing measures when surgeons and nurses performed the surgical task. Inter-rater reliability (IRR) was assessed by Kendall's tau b coefficient. An 80% power parallel block randomization design at alpha = .05 required 60 subjects.
  
  
  RESULTS
  Thirty-two post-call surgeons and 32 post-work surgeons were well matched for age, gender, practice duration, and ESS and MIST-VR scores. The amount of time slept in the previous 24 hours was 1.5 versus 6.5 hours (P < .05). AE (1.0 mm vs. .5 mm), TD (2.18 mm vs. 2.18 mm), LR (56.2% vs. 65.6%), GDA (33.5 vs. 32.5), NGDA (.56 vs. .31), and OT (381.0 seconds vs. 364.5 seconds) were not significantly different when 32 surgeons in the post-call arm were compared with their 32 counterparts in the post-work arm, respectively. Construct validity was shown by significant improvement in 4 outcome measures (AE 1.0 mm vs. 2.0 mm, P = .00001; GDA 32.5 vs. 39.0, P = .07, NGDA .43 vs. .96, P = .045; and OT 377.5 vs. 557.0, P = .0005) when 64 surgeons performed the task as compared to 64 nurses. Tau b for IRR was 1.0 (P < .0001) for AE, TD, LR, and OT, .75 (P = .325) for GDA, and .77 (P = .305) for NGDA.
  
  
  CONCLUSIONS
  Sleep deprivation had no impact on the studied outcome measures of a surgical task performed in a laparoscopic simulator.
authors.affiliation: Department of Research and Development, Forde Health System, University of Bergen, Forde 6807, Norway.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Uchal
authors.forename: Jostein
authors.initials: J
authors.lastname: Tjugum
authors.forename: Egil
authors.initials: E
authors.lastname: Martinsen
authors.forename: Xinguang
authors.initials: X
authors.lastname: Qiu
authors.forename: Roberto
authors.initials: R
authors.lastname: Bergamaschi
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008505:Medical Staff, Hospital; D009664:Norway; D009741:Nursing Staff, Hospital; D010439:Peptic Ulcer Perforation / Q000601:surgery; D015203:Reproducibility of Results; D012892:Sleep Deprivation; D013536:Suture Techniques