title: What are the effects of sleep deprivation and fatigue in surgical practice?
abstract: Sleep deprivation and fatigue have long been linked with accidents in high-risk industries and serious errors in the medical profession, but their effects on surgical performance are less well understood. This article outlines the important functions that human sleep serves and describes the neurobehavioral effects of wakefulness extension and mental fatigue that are relevant to surgical performance, including attentional failure, risk taking, and decision-making bias. Methods used to explore the effects of sleep deprivation and fatigue on surgical performance, from laboratory studies to outcomes data, are discussed; the findings are summarized; and important deficiencies in the literature are highlighted. Future strategies to mitigate performance decline, such as novel assessment tools and countermeasures with proven efficacy, are presented, and their deployment is discussed in the context of key ethical principles.
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, United Kingdom. c.sugden@imperial.ac.uk
authors.forename: Colin
authors.initials: C
authors.lastname: Sugden
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D001288:Attention; D002755:Choice Behavior; D002983:Clinical Competence; D003071:Cognition; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency; D005222:Mental Fatigue / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D009048:Motor Skills; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000941:ethics; D018570:Risk Assessment; D012307:Risk Factors; D012309:Risk-Taking; D012892:Sleep Deprivation / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D013514:Surgical Procedures, Operative / Q000193:education* / Q000941:ethics; D013997:Time Factors; D016526:Workload