Surgeon fatigue does not affect surgical outcomes: a systematic review and meta-analysis
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REVIEW ARTICLE
Surgeon fatigue does not affect surgical outcomes: a systematic review and meta‑analysis Naoya Koda1 · Yoko Oshima2 · Keiji Koda3 · Hideaki Shimada4 Received: 26 May 2020 / Accepted: 26 July 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose To systematically review the effects of surgeon fatigue on postoperative mortality and postoperative complications after elective and non-elective surgeries. Methods A database search was conducted for original articles published in PubMed between 2000 and 2020 with the keywords: “surgeon,” “sleep deprivation,” “sleep deprived,” “fatigued,” “mortality,” “morbidity,” and “outcomes.” We selected articles that disclosed actual numbers of patients who underwent surgery by fatigued or rested surgeons, rates of postoperative mortality, or total postoperative complications. Results Of the 1427 articles identified, 16 met the selection criteria and were included. Eight of the 16 also included total postoperative complications. Analysis revealed no significant differences in the rates of postoperative mortality after elective and non-elective surgeries or total postoperative complications of elective surgeries or non-elective surgeries performed by fatigued vs. rested surgeons. The relative risks were 1.03 [95% confidence interval (CI), 0.86–1.24], 1.08 (95% CI, 0.85–1.38), 0.99 (95% CI, 0.95–1.04), and 0.93 (95% CI, 0.67–1.28), respectively. Conclusion Surgeon fatigue does not affect the rates of postoperative mortality or total postoperative complications after elective surgeries and may have little to no effect on the rates of postoperative mortality or total postoperative complications after non-elective surgeries. Keywords Surgeon · Fatigue · Surgical outcome · Mortality · Morbidity
Introduction The effect of surgeon fatigue on clinical outcome has been a topic of great debate for decades. In an editorial titled “The tired surgeon” in 1965, Schenk [1] raised the question of whether it is in the patient’s best interest for sleep-deprived residents to perform an operation. Almost 40 years later, in * Hideaki Shimada [email protected]‑u.ac.jp 1
Toho University School of Medicine, 5‑21‑16, Omori‑nishi, Ota‑ku, Tokyo, Japan
2
Division of Gastroenterological Surgery, Department of Surgery, Toho University Medical Center, Omori Hospital, 6‑11‑1 Omori‑nishi, Ota‑ku, Tokyo 143‑8541, Japan
3
Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
4
Department of Gastroenterological Surgery and Clinical Oncology, Graduate School of Medicine, Toho University, 6‑11‑1 Omori‑nishi, Ota‑ku, Tokyo, Japan
2003, the accreditation council for graduate medical education in the United States put into effect a work-hour reform that established a maximum 80 h workweek for medical residents. This reform was prompted by concern over the negative effect of restricted sleep on performance [2, 3]. Over the past two decades, numerous cohort studies have been conducted to assess the effect of surgeon fatigue on surgical ou
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