Working the overnight shift prior to performing daytime elective surgery was not associated with a significant increase in surgeons' rates of adverse outcomes, according to the results of a study published in the August 27, 2015, issue of the New England Journal of Medicine. The study included 38,978 Canadian patients who underwent 1 of 12 daytime surgical procedures (cholecystectomy, gastric bypass, colon resection, coronary-artery bypass grafting, coronary angioplasty, knee replacement, hip replacement, repair of a hip fracture, hysterectomy, spinal surgery, craniotomy, and lung resection) between January 2007 and December 2011. For comparison, the researchers matched patients whose procedures were performed by a physician who had just worked the overnight shift (12:00 am to 7:00 am) in a 1:1 ratio with patients whose procedures were performed by the same physician on a day when the physician had not worked the overnight shift the night before. They found no significant difference in a combined rate of death, complication, and readmission between patients who underwent a daytime procedure performed by a physician who had worked the overnight shift (22.2%) and those who underwent a procedure performed by a physician who had not worked the overnight shift (22.4%). In addition, the data indicated no significant difference in outcomes after stratification for academic versus nonacademic center, physician age, or type of procedure. The researchers conclude that their findings suggest that calls for broad-based policy shifts in duty hours and practices of attending surgeons may not be necessary at this time. However, they note that the effect of profound sleep loss warrants further study and emphasize that physicians should critically assess the effects of all sources of fatigue on their individual ability to treat patients and self-regulate their practices appropriately.

HRC Recommends: Healthcare fatigue and its impact on patient safety remain a high-profile topic. While the results from the Canadian study are intriguing, the findings are inconsistent with other studies that have found that sleep deprivation can impair cognitive processes and adversely affect cognitive clinical performance. Healthcare organizations should implement fatigue management strategies as part of their system-wide efforts to increase patient safety and reduce medical errors.