Healthy Living: Your Surgical Risks
Does Your Surgeonâ€™s Lack of Sleep Affect Your Surgical Risk?By- Dr. Joan Marie PellegriniSince we are all just a bit sleep deprived because of the time change, I thought it would be appropriate to cover the topic of sleep deprivation for this segment. I have covered this topic before but not as it concern the surgeon and the patient. It is not news nor is it controversial that all of us function better after a full night of sleep. We know that truck drivers and pilots are not allowed to drive/fly after working a determined number of hours and that there is a mandated amount of sleep time between shifts of work. Most of us are also aware of the work hour limits that have been placed on residents in medical training. However, there are no policies regulating how much sleep your surgeon must have before performing your electively scheduled surgery. This is a truly controversial topic because so many people have such strong feeling about it. Unfortunately, although there are strong feelings, there is little data to demonstrate how prevalent or how dangerous is this problem.There is at least one study (JAMA 2009) that demonstrates an increased complication rate when the general surgeon has had less than six hours of sleep. A recent editorial in the New England Journal of Medicine also raises this issue. This editorial addressed the specific issue of elective general surgery cases and how much should the surgeon disclose to the patient about their sleep habits the previous night. Patients and surgeons have several reasons why they may not want their surgery cancelled. Patients have mentally prepared for undergoing a procedure, arranged for time off work, arranged for childcare, etc. The surgeonâ€™s schedule also may not be very accommodating to rescheduling. And, the hospitalâ€™s OR schedule may not have any vacancies in the near future.In concert with the above scheduling issues is the fact that most of us are excellent at denying that sleep deprivation is so dangerous. Many of us, me included, have driven on the highway sleep deprived because we only had a few more miles to go. We say to ourselves: â€œI can do this. Iâ€™m not really going to fall asleep and crash.â€ When we are a patient, we expect our surgeon to be â€œtoughâ€. We believe that surgeons go through such grueling training in order to be able to handle the schedule. We often have no concern about the ability of our surgeon to function on little sleep.What type of elective surgery you are having also has an impact. If it is a minor procedure or one with little risk, then there are little data showing any compromise in care from a sleep deprived surgeon. This is because much larger studies are required to demonstrate a difference in outcomes when there is low risk of complication. My personal opinion is that patients receive excellent care for low risk procedures even when their surgeon is sleep deprived.If you are undergoing a lengthy or risky procedure then you may consider requesting your elective procedure be scheduled on a date that is not a â€œpost-callâ€ day. The day after a surgeon has been on call the night before is commonly referred to as the â€œpost-callâ€ day. Depending on what kind of practice your surgeon is in, their nights of call and covering the Emergency room may or may not be busy. None the less, if you have a choice, it is probably better to avoid a â€œpost-callâ€ day. Fortunately, it is becoming more common for busy surgeons not to schedule elective procedures on post call days. Second, it is permissible to ask your surgeon before your procedure how many hours of sleep they had the night before. This question should be no more controversial than asking your surgeon at your consultation appointment how many procedures they have performed or what their complication rate is. I will admit that it is a rare patient of mine that asks me any of these questions. Iâ€™m not sure if it because they are afraid to know the answer or they are unaware of the risk of surgeonsâ€™ sleep deprivation.It is my hope in the near future that patients and surgeons will become more aware of this issue. The solution will not be simple. Clearly, we cannot mandate a limit to the hours worked by surgeons. There is already a national shortage of general surgeons. Such a mandate would put patients at significant risk and perhaps would limit access to emergency surgical care. Also, surgeons have fluctuating needs for sleep depending on the influence of other stressors is in their life and what point they are in their career.It is my hope the healthcare industry will work toward awareness and solutions before the government becomes involved with mandates. Educated patients who ask intelligent questions of their doctor help ensure better care for themselves and other patients.References:NEJM 2010: 363:2577-2579.JAMA 2009: 302:1565-1572.General Surgery News February 2011.