(Reuters Health)—Going without sleep the night before does not affect the performance of doctors doing elective surgery the next morning, according to a new Ontario study that runs contrary to research demonstrating that sleep-deprived physicians pose a hazard to patients.
The odds of having a surgery-related problem were 22.2% when the doctor had been treating patients between midnight and 7 a.m. and 22.4% when the doctor had, presumably, received sufficient sleep.
The senior author of the study, Dr. Nancy Baxter of the University of Toronto, told Reuters Health in a telephone interview that the new results argue against proposals calling for doctors to inform their patients if they are sleep-deprived.
But the study didn’t directly measure how much sleep the doctors actually received, said Dr. Charles Czeisler, chief of the division of sleep and circadian disorders at Brigham and Women’s Hospital in Boston. He was not connected with the research.
According a 2009 study that he and his colleagues published in JAMA, once the actual amount of sleep is taken into consideration, the odds of a serious mistake nearly triple.
“Given the increased risk that we’ve seen with just one night of insufficient sleep, patients have the right to know if their doctor has been awake for one night, two nights, or even three consecutive nights,” he told Reuters Health by phone.
The Baxter study, released Aug. 26 in The New England Journal of Medicine, was based on data from 147 hospitals in Ontario. It looked at nearly 39,000 cases performed by 1,448 experienced surgeons.
The researchers tracked 12 widely-varying types of operations, from bypass surgery and hip replacement to hysterectomy and angioplasty, done during a five-year period. A billing code database told them whether the doctor had worked from midnight to 7 a.m. the night before the operation.
Thirty days after surgery, the odds of death were 1.1% whether or not the doctor had worked during the early morning hours before the operation. The readmission rates were 6.6% if the surgeon had been up late and 7.1% if he or she had not. The 30-day complication rate was 18.1% in the overnight group and 18.2% when overnight work was not a factor. In both groups, half the patients went home in three days or less.
The type of hospital, the doctor’s age and the type of operation made no difference.
Czeisler said he and his colleagues reported similar results in their 2009 study of 4,471 cases.
