Attending surgeons and obstetricians/gynecologists who worked nighttime hours did not have a significantly greater rate of complications for procedures performed the next day, but having less than six hours of opportunity for sleep between procedures was associated with an increased rate of surgical complications, according to a study in the October 14 issue of JAMA, a theme issue on surgical care.
Jeffrey M. Rothschild, M.D., M.P.H., of Brigham and Women's Hospital, Boston, presented the findings of the study at a JAMA media briefing in Chicago.
There has been increasing public attention on the role of resident physicians' fatigue in the occurrence of medical errors. In 2003, work hour limits were implemented for resident physicians in the U.S. Work hours of attending physicians are not restricted. "Little is known about the frequency of elective surgical and obstetrical/gynecologic procedures by attending physicians who participate in emergency procedures the night before. Even less is known about the risks of complications during these postnighttime procedures," according to background information in the article.
Dr. Rothschild and colleagues examined the relationship between nighttime work hours, sleep, and rates of complications in procedures performed the next day. The researchers analyzed data on procedures performed from January 1999 through June 2008 by attending physicians (86 surgeons and 134 obstetricians/gynecologists) who had been in the hospital performing another procedure involving adult patients for at least part of the preceding night (12 a.m.- 6 a.m., postnighttime procedures). A total of 919 surgical and 957 obstetrical postnighttime procedures were matched with 3,552 and 3,945 control procedures, respectively. Control procedures included those of the same type performed by the same physician on days without preceding overnight procedures.
The researchers found that complications occurred in 101 postnighttime procedures (5.4 percent) and 365 control procedures (4.9 percent). There was no difference detected in types of complications between postnighttime and control procedures. The most common surgical complications were organ injuries and bleeding.