PALM BEACH, FLA. – Surgeons who performed routine, elective operations the day after they spent all night working an in-hospital shift in the trauma unit had no increased rate of complications, no need for hospital readmissions, and no mortality among their elective cases in a single-center review of 869 cases.
The findings suggest that "there remains no compelling evidence to mandate work-hour restrictions for attending general surgeons," Dr. Martin A. Croce said at the annual meeting of the Southern Surgical Association.
"No study to date has evaluated the effect of sleep deprivation on outcomes specific to the practice of general surgery. This study looked at the impact of an overnight shift in a busy trauma center on the outcomes of typical general surgery procedures performed the next day" and found no significant difference in outcomes between post-call and non–post-call surgeons with respect to postoperative complications, readmissions, or deaths, said Dr. Croce, professor of surgery and chief of the division of trauma and critical care at the University of Tennessee Health Science Center in Memphis.
"These results confirm my bias, but the study was limited by its retrospective, single-institution nature, and by only including tertiary teaching patients. Each [surgeon] must continue to use judgment when deciding whether to perform elective operations after a busy night on call," commented Dr. William G. Cioffi Jr., professor and chairman of surgery at Brown University, Providence, R.I.
Dr. L.D. Britt
"It is unclear to me that the surgical community will need to present these results because there has been no call for work-hour restrictions for attendings, nor do I feel there will be," said Dr. L.D. Britt, professor and chairman of surgery at Eastern Virginia Medical School, Norfolk.
In his study, Dr. Croce reviewed patients who underwent any of three types of general surgeries at his institution during January 2006 to April 2009 by one of the nine attending surgeons in the department. The review comprised 869 procedures: 46% were hernia repairs, 35% were cholecystectomies, and 19% were bowel operations. The primary outcomes were 30-day postsurgical mortality, 30-day postsurgical readmissions, and procedure-related complications: wound infections, seroma, injured adjacent structures, intra-abdominal abscess, hemorrhage, dehiscence, leak, or perforation of the gallbladder during laparoscopic cholecystectomy. Overall, patients had a 13% complication rate, a 5% readmission rate, and mortality of less than 1%.
Among the 869 procedures, 132 (15%) were done by surgeons following a night on call and the remaining 737 (85%) were done by surgeons not on call the prior night. In a multivariable regression analysis that controlled for patient’s age, urgency of the elective surgery, and comorbidities, the rates of complications, readmissions, and deaths were similar between those done by surgeons following a night on call and those done without working the night before, Dr. Croce reported.
Further analyses showed no significant difference between the two surgeon subgroups when the types of procedures were broken down into hernia repair, cholecystectomy, or bowel operation.
A limitation of the study was that the findings apply only to these three types of surgeries; they should not be extrapolated to other, more complex surgeries, said Dr. John P. Sharpe, a surgeon at the University of Tennessee who collaborated with Dr. Croce on the study.
Dr. Croce, Dr. Cioffi, Dr. Britt, and Dr. Sharpe had no disclosures.