Surgery and Sleep Deprivation

New England Journal of Medicine, December 30, 2010 (N ENGL J MED 363;27)

Very interesting document regarding sleep deprivation and scheduled elective surgery.  It is an easy read and only 3 pages long.  Of interest to me was the following statement; “In surgery, there is an 83% increase in the risk of compilations (e.g., massive hemorrhage, organ injury, or wound failure) in patients who undergo elective daytime surgical procedures performed by attending surgeons who had less than 6-hour opportunity for sleep between procedures during a previous on-call night.   The reference sited for that statement was (Rothschild J M, Keoheane C A, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures JAMA 2009.
A 2008 study was sited for this next statement; “Sleep deprivation adversely affects clinical performance and impairs psychomotor performance as severely as alcohol intoxication”.
 
The Journal continues, “As a first step, we recommend that institutions implement policies to minimize the likelihood of sleep deprivation before a clinician performs elective surgery and to facilitate priority rescheduling of elective procedures when a clinician is sleep-deprived. 
Sleep deprivation could be due to the loss of sleep because of a chronic problem, or repeated interruption, ( calls from the residents, or perhaps a sick spouse or child). How would you know if the surgeon that you have chosen for this job has had a sleepless night.?  The question is that given the above information from the New England Journal of Medicine, would you make it a condition of the informed consent that the physician disclose to you immediately preoperative if he or she had less than (you pick the number)  hours of sleep prior to performing a major surgery? Or is this a non-issue to you?
 
I’d be interested in thoughts and comments about this...
 
I have always found it interesting here on HW about the minimal number of surgeries needed, as perceived by the individual, before someone is considered “skilled enough to operate on me”. That number ranges from just a few... to a gazillion.  However; it would appear that it is as important, to established that the surgeon isn’t tootered or sleep deprived, regardless of the number. 
Hero

Hi Hero, really interesting!

Obviously, a sleeply genius isn't great. But, better than an average surgeon who is alert and at the top of their game?

For me it is just further evidence that a focus on the number of surgeries performed, rather than quality of surgeries performed, is a danger. The root cause is likely that, as lay people, we can ask about number of surgeries, but to really do due diligence is difficult, if not impossible, and seeing through a mirror darkly is better than not seeing at all.

My concern is always that the emphatic advice sometimes given here about surgery numbers as being so critical will mislead newcomers into thinking that once they know that number, they've got all the key information they need, rather than thinking it's an interesting number, and a worthwhile thing to know, but NOT the question their own doctor would be putting significant weight on if they were the one headed for a RP. They'd be interested in results, measured by everything from time spent under general anesthetic, to post surgical complications, to pathology margins, etc. etc. etc.

One thing I've got on my list to ask about now is whether or not the surgeon is, as you so delightfully put it, "tootered."

Sheldon AKA Sleepless

Purg,

You are a better man than I am.  I doubt I could be as supportive as you are of doctors in a "smaller area" if I had experienced what happened to you over the past few years.  I don't think I would still be able to say - to use your words - "i am compliant to my doctors, their advice, and their orders."

In any event, flip this thread around.  What is the effect of a patient's lack of sleep the night before major surgery?  I have had seven surgeries in the past few years, and anxiety and stress didn't make for a good night's sleep before any of them.  How does that factor in to the issue of how a patient's body responds to the physical stresses of surgery, particularly unforeseen stresses that arise during emergencies? 

For that matter, most people find it practically impossible to get a good night's sleep in a hospital after surgery.  How does that affect healing?

Zen9

Don't these stats relate to ALL surgery and not just Da Vincis. Uro's surely aren't scheduling a robot op at midnight are they. Mine did/does one at about 7am and another at about 11am.

In the army my dad operated non-stop for 72 hours while under bombardment. But I don't think he would have wanted to di that every week!!!

Alf

Well, I kinda asked what day my surgeon would be "at his best" and his nurse half jokingly mentioned Monday AM was good.

I just hope that my dude wasn't having some fun-lovin' drunken Caligula-like party the Sunday before....

I suppose by the end of next Monday I'll know for sure.

My surgeon called me at home (~8:00 Monday evening) the night before the surgery, to make sure I was ok and if I had any other questions.
I don't know if he went out drinking after calling me but it was comforting to know he was most likely at home and at least thinking about where his hands would be 11 hours later. I was first up to the plate. He did two other guys the same day.

(It was also comforting for me to know he was married with 2 kids around 10 years old.)

Fairly or unfairly, I don't want my surgeon to be a single, party boy with HOTDOC custom license plates on his BigMoneyWaster M6.

Jeff

How many of us would appreciate the pre-surgery call. Should it be mandatory?

I was pretty much sleep deprived on the day I went in for surgery. Probably hadn't had two hours sleep any night for the months since diagnosis. Everyone tells about seeing the robot - I was hard cold out before I was out the door of the prep area. I did not see the robot -