Acute care surgery performed by sleep deprived residents: are outcomes affected?
BACKGROUND
The Institute of Medicine recently recommended further reductions in resident duty hours, including a 5-h rest time for on-call residents after 16 h of work. This recommendation was purportedly intended to better protect patients against fatigue-related errors made by physician trainees. Yet no data are available regarding outcomes of operations performed by surgical trainees working without rest beyond 16 h in the current 80-h workweek era.


METHODS
A retrospective review of all laparoscopic cholecystectomies (LC) and appendectomies performed by surgery residents at a public teaching hospital from July 2003 through March 2009. Operations after 10 PM were performed by residents who began their shift at 6 AM and had thus been working 16 or more hours. An outcomes comparison between time periods was conducted for operations performed between 6 AM and 10 PM (daytime) and 10 PM and 6 AM (nighttime). Outcome measures were rates of total complications, bile duct injury, conversion to open operation, length of surgery, and mortality.


RESULTS
Over the 7-y study period, 2908 LC and 1726 appendectomies were performed. Appendectomies were performed laparoscopically in 73% of cases in patients for both time periods. There were no differences in rates of overall morbidity and mortality for operations when performed in nighttime compared with daytime. On multivariable analysis, there were no differences in outcomes between the two groups.


CONCLUSIONS
The two most commonly performed general surgical operations performed at night by unrested residents have favorable outcomes similar to those performed during the day. Instituting a 5-h rest period at night is unlikely to improve the outcomes for these commonly performed operations.
Yaghoubian
Arezou
A
Department of Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
Kaji
Amy H
AH
Ishaque
Brandon
B
Park
Jon
J
Rosing
David K
DK
Lee
Steven
S
Stabile
Bruce E
BE
de Virgilio
Christian
C
D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D012189:Retrospective Studies; D012892:Sleep Deprivation; D016896:Treatment Outcome