The Risk of Sleepy Surgeons

January 11th, 2011. By Hunter West

There was a study recently that demonstrated sleepy drivers were just as careless, just as accident-prone and just as dangerous as people who were driving drunk. Sleep deprivation, the researchers found, was just as much an impairment as being high on alcohol. 

So what about doctors? What about surgeons? 

An editorial that came out December 30^th in the New England Journal of Medicine (NEJM) makes that same point for medical professionals. To wit, sleepy doctors are potentially as impaired as drunken doctors. 

It’s something, as patients, we never think about. But think about it—how many times have you been caught yawning on the job? How many times have you nodded off at the computer? How many times have you had to pull over while driving endless miles along a highway, in order to catch a bit of rest because you feel yourself nodding off? 

Should we not assume that surgeons are capable of the same sleepiness? 

The concern is certainly warranted, according to the authors of the NEJM editorial. And one can certainly understand the issue. As an example, a surgeon who has not slept all night following emergency bowel surgery throughout the wee hours is seen scrubbing up for an elective colostomy at nine the following morning. 

Pretty scary thought, huh? 

The editorial authors say that sleepy surgeons should not be allowed to operate without a patient’s written, informed consent provided the institution has no policy in place governing the issue. 

“We don’t believe that patients should have to make the decision (over whether surgery should proceed)—institutions should take responsibility for this,” says lead author Dr. Michael Nurok, an anesthesiologist and intensive care physician at the Hospital for Special Surgery in New York. 

“Institutions should say, ‘we’re simply not going to permit surgeons to schedule elective cases on the day after a night on call.’ That avoids the issue altogether.” 

Well, duh… 

Why would any hospital allow an elective operation to be performed by a surgeon immediately following an on-call shift? 

To be fair, hospitals don’t want to have to reschedule surgeries willy-nilly. And there will be times when a doctor, even when not on call, will be involved in an emergency consultation or procedure involving a patient that was not foreseen. If that happens immediately prior to elective surgery, then okay—perhaps the surgery should be moved. 

But is allowing the scheduling of elective surgeries on the heels of a scheduled on-call shift, just asking for trouble? 

Duh, again…  

If the hospital fails to take the bull by the horns, then the doctrine of informed consent should prevail, Nurok says. “And that simply says that any patient having any elective procedure has the right to be informed of the risks, the benefits and the alternatives to that procedure. And there is now clear data to show that there is an increased risk” from drowsy operating. 

The American College of Surgeons rebutted the editorial. In a response published by the NEJM, the college says mandatory disclosure is unwarranted, and that most “professionals of this caliber” would find the recommendation that they be forced to disclose how many hours they’ve slept “oppressive and insidious. 

“Many other factors—including marital difficulties, an ill child, financial worries, and so on—negatively affect performance. Are we going to demand full disclosure of these problems as well?” 

Well no, but look at the facts… 

A 2009 study published in the Journal of the American Medical Association involving post-nighttime procedures found an 83 per cent greater risk of complications when surgeons had less than six hours sleep. The most common surgical complications were organ injuries and bleeding. 

In Canada, McGill University hospitals have eliminated 24-hour shifts for residents in internal medicine. But there are no such regulations for fully trained doctors, say the editorial authors. 

That might give you pause, the next time you go under the knife for an elective procedure. 

Worse, if your bowel is nicked, or a sponge is left in, or there is some other slip or complication, the first question for any lawyer representing a client in a medical malpractice lawsuit is, ‘how much sleep did the surgeon have? And what are the hospital’s scheduling protocols?’ 

This is a hotly contested topic amongst those in the medical community. While the debate rages, all the rest of us can do is sit by the sidelines and pray for sleep—for our surgeon.

Tags: medical malpractice, NEJM, Sleep, Surgeon

This was posted on Tuesday, January 11th, 2011 at 8:33 am and is filed under Drugs/Medical, Emerging Issues . Feel free to respond, or trackback. Read our comments policy.