Study: Physicians Working Overnight Not Linked to Significantly Increased Risk of Complications

Oct. 21, 2009
Attending surgeons and obstetricians/gynecologists who worked nighttime hours did not have a significantly greater rate of complications for procedures performed the next day, but having fewer than 6 hours of opportunity for sleep between procedures was associated with an increased rate of surgical complications, according to a study in the Oct. 14 issue of JAMA.

The role of resident physicians’ fatigue in the occurrence of medical errors has garnered increasing public attention. In 2003, work hour limits were implemented for resident physicians in the United States. Work hours of attending physicians are not restricted.

“Little is known about the frequency of elective surgical and obstetrical/gynecologic procedures by attending physicians who participate in emergency procedures the night before. Even less is known about the risks of complications during these post-nighttime procedures,” the article stated.

Along with colleagues, Jeffrey M. Rothschild, M.D., M.P.H., of Brigham and Women’s Hospital in Boston examined the relationship between nighttime work hours, sleep and rates of complications in procedures performed the next day. The researchers analyzed data on procedures performed from January 1999 through June 2008 by attending physicians who had been in the hospital performing another procedure involving adult patients for at least part of the preceding night (12 a.m.- 6 a.m., post-nighttime procedures). A total of 919 surgical and 957 obstetrical post-nighttime procedures were matched with 3,552 and 3,945 control procedures, respectively. Control procedures included those of the same type performed by the same physician on days without preceding overnight procedures.

Complications

The researchers found that complications occurred in 101 post-nighttime procedures (5.4 percent) and 365 control procedures (4.9 percent). There was no difference detected in types of complications between post-nighttime and control procedures. The most common surgical complications were organ injuries and bleeding.

According to the researchers, a higher rate of procedural complications occurred among post-nighttime cases when there were 6 or fewer hours of sleep opportunity (6.2 percent, compared to 3.4 percent with more than 6 hours of sleep opportunity). This predominantly was due to surgical complications. Furthermore, post-nighttime procedures performed when work duration exceeded 12 hours showed non-significantly higher complication rates compared with shifts of 12 hours or less.

“These data suggest that attending physicians, like residents and nurses, may be at increased risk of making errors when sleep deprived or working extended shifts,” the researchers wrote.

“Our data suggest that the business as usual of a ‘limitless work week’ for attending physicians is not optimal for patient care,” they added.

The authors offered several initiatives that could lessen the risks of unsafe levels of fatigue during procedures, including having large physician groups avoid scheduling elective procedures following overnight on-call responsibilities; implementing a culture of teamwork and critical redesign of schedules; and, when possible, having adequate backup personnel available to relieve fatigued physicians.

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