Sleepy Surgeons: The effect of sleep deprivation on surgical performance
School of Medicine PhD researcher found that surgeons were already sleep deprived before their on-call shifts and were even more sleep-deprived afterwards, and crucially, that sleep deprivation impacted surgical performance.
PhD candidate Dale Whelehan investigated sleep deprivation and surgical performance focusing on the effects of being ‘on-call’, a frequent state for surgeons particularly in their earlier years of training. Surgery is clearly a high-stake industry, and highly skilled professionals frequently work 24 straight hours (or more) resulting in unavoidable sleep disturbance. The reasons for this are likely to be historic. During the Halsteadian Era of Surgery, the theory of learning was that one had to ‘reside’ in the hospital in order to properly learn, and vestiges of this theory still remain. Culture plays a significant role in professional practice and hidden curricula contribute to professional identity formation. Dale explained the aims of the research:
“Our objective was to explore subjective and objective metrics around sleep and performance using on-call as a particular influencer for increased fatigue. We recruited surgical trainees and consultants from Tallaght University Hospital”
Participants completed electroencephalogram testing using a modified Multiple Sleep Latency Test testing to objectively measure sleep, as well as several validated tests for subjective sleep measurement. Performance was measured using standardised performance assessment tools. Dale described some of the key findings:
“We found that surgeons had poor baseline sleep quality, and that they were objectively sleep-deprived, even pre-call. This sleep deprivation then increased significantly in post-call states. We found a reduction in performance associated with sleep deprivation, and tasks with higher cognitive demands, in other words tasks that were more difficult to do, were affected more than easier tasks.”
The research found that the current models of surgical on-call were not conducive to optimising sleep for surgeons. However, there are challenges associated with making changes to ensure better sleep. For example, there may be loss of continuity of patient care, loss of trainee exposure, and reduced service delivery. Nevertheless, patient safety is of utmost importance to healthcare workers. Dale explains:
“This is about supporting surgeons in making meaningful change to help manage their fatigue – and a big part of that is around self-awareness and removing barriers to effective change. The impact of our findings in driving change is the million dollar question! We need to look at multifactorial causes and effects of fatigue. Regulation and resource management must go hand-in-hand. Ultimately, this is about building a system that better supports healthcare workers. By optimising human factors we certainly serve to optimise performance in the personal and professional sense.”
This work was supervised by Professor Paul Ridgway and had multidisciplinary collaboration including Dr Michael Alexander, and Christine McEvoy (both Tallaght University Hospital), as well as Dr Tara Connelly (Cleveland Clinic). This work was part of a suite of studies on surgical performance and fatigue conducted as part of Dale’s PhD studies.
The study was published in the Journal of Surgical Research and is accessible here: https://www.journalofsurgicalresearch.com/article/S0022-4804(21)00427-3/fulltext