Effect of Physician Fatigue on Subsequent Day Surgeries

With surgeons frequently performing overnight urgent procedures, there is reasonable concern that fatigue could adversely affect these same surgeons performing operations the following day. However, the connection between physician fatigue and subsequent day surgery outcomes has been previously difficult to examine due to methodological and data limitations. A recent report in JAMA Internal Medicine by Professor of Health Care Policy, Bapu Jena, MD, PhD, and colleagues, examined the relationship between physician fatigue and surgical outcomes.

The study used data from 20 high-volume US institutions, analyzing a large multicenter registry of patients who underwent surgical procedures from 2010-2020. The primary outcomes measured were in-hospital death or major complications, such as sepsis, pneumonia, myocardial infarction, thromboembolic event, or stroke, with secondary outcomes including operation length, and individual outcomes of death, major complications, and minor complications such as surgical site infection or urinary tract infection.

Analysis revealed that among 498234 daytime operations performed by 1131 surgeons, only 13098 (2.6%) involved an attending surgeon who had operated the prior night. Moreover, the adjusted incidence of in-hospital death or major complications was 5.9% among daytime operations performed by a surgeon who had operated the night before compared with 5.9% when the same surgeon did not perform the previous night.

The study indicated that there was no association between overnight work and secondary outcomes except for operation length; overnight procedures did result in slightly shorter surgeries the next day, however, the difference was unlikely to be meaningful.

Overall, the study suggests that when surgeons work overnight, the care that they provide patients the following day does not suffer.