Sleep vs. no sleep

Leaving your heart in the hands of a sleepy surgeon may sound terrifying, but according to a new Canadian study there is little to worry about.

Over six years, patients at London Health Sciences Centre in Ontario fared equally well when their surgeons were well rested as when they were operating on less than three hours of shuteye.

"This is certainly reassuring to the public," said Dr Michael Chu, a heart surgeon at the centre, who worked on the study. "They don't have to worry about surgeons being sleep deprived."

The findings add to a long-standing debate over the safety of trusting red-eyed doctors with life-and-death operations that require quick thinking and lots of dexterity.

While studies have shown that a lack of sleep leads to a drop in both mental and manual skills, it has not been clear how that affects performance in the operating room.

Not all experts convinced

"I don't think this is necessarily reassuring," Dr Jeffrey M. Rothschild, of Brigham and Women's Hospital in Boston, said. "There is a reason why pilots don't fly if they didn't sleep the night before."

In a study of more than 200 doctors from 2009, Dr Rothschild and his colleagues found that the number of complications nearly doubled when surgeons operated on less than six hours of sleep.

The new study, by contrast, followed only six heart surgeons with a total of 4,000 surgeries over six years.

About 40% of the time, the surgeon said they'd slept between three and six hours; 2% of the time they'd gotten less than three hours.

During the surgeries, 3.6% of the patients died when the surgeons had slept no more than three hours, compared to 2.8% when they'd had three to six hours and 3.4% when they'd rested longer.

Those small differences might easily have been due to chance, the researchers report in the Archives of Surgery.

Major complications such as stroke or kidney failure occurred in 15% of cases when surgeons had been bunking for less than six hours and 17% when they'd slept more.

More comfort

"We feel comfortable continuing on with our practice the way it is, knowing that patient safety is not compromised," Dr Chu said.

He said teamwork and long hours of training with little sleep might explain why heart surgeons appear to cope well with a lack of downtime.

Dr Kanav Kahol, who has studied sleep deprivation at Banner Good Samaritan Medical Centre in Phoenix, warned that the results should be interpreted cautiously.

"It is well known from research including ours that the impact on clinical outcomes of sleep deprivation is a function of experience and specialty," he said.

"Residents do make more errors in sleep deprived condition than attending (physicians)," he added, "and while neurosurgeons don't seem to be impacted with fatigue, general surgeons do."

Limit on duty hours

Several countries, including the US, recently put limits on the maximum duty hours and on-call time for resident doctors in an attempt to improve patient safety.

Dr Chu worried that strategy might backfire.

"Perhaps we are conditioned to be able to perform better under these circumstances," he ventured. "The rigidity of the new rules could potentially be sacrificing patient safety in the future."

In Dr Rothschild's eyes, that's baseless speculation.

"I don't agree that you get a baked-in skill set by operating on no sleep," he said. "It is a real leap to make that statement."

(Reuters Health, Frederik Joelving, May 2011)

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