Procedures performed day after overnight procedure by same physician not associated with increased risk for complications

Daytime procedures performed by an attending physician who performed an overnight procedure just prior were not significantly associated with increased complication rates, but results indicated an increased rate of complications for procedures in which physicians had sleep opportunities of fewer than six hours.

Researchers examined 919 surgical procedures and 957 obstetrical post-nighttime procedures. The surgical procedures were matched with 3,552 control procedures and the obstetrical procedures were matched with 3,945 controls. Eighty-six (17.5%) surgeons and 134 (40.5%) obstetricians/gynecologists performed the procedures.

According to the researchers, complications occurred in 101 (5.4%) post-nighttime procedures and in 365 (4.9%) control procedures (OR=1.09; 95% CI, 0.84-1.41). No significant difference in complication rates was reported between the post-nighttime and control procedures. The most common surgical complications reported were organ injuries and bleeding, and surgical site infections and organ injury were the most common complications among those undergoing obstetrical procedures.

The overall duration of post-nighttime labor and delivery procedures was longer when compared with control procedures (P=.002). A higher rate of procedural complications occurred when there were six or fewer hours of sleep opportunity (6.2%) when compared with post-nighttime procedures in which there were more than six hours of sleep opportunity (3.4%; OR=1.72; 95% CI, 1.02-2.89). There was also a trend toward higher complication rates for post-nighttime procedures completed after working .12 hours compared with those performed after working <12 hours (6.5% vs. 4.3%; OR=1.47; 95% CI, 0.96-2.27). The researchers reported no significant differences in the severity of complications between the post-nighttime procedures and control procedures.

“Overall, procedures performed following overnight cases were not associated with a significant increase in complications,” Jeffrey M. Rothschild, MD, an associate physician at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School in Boston, said in a press briefing today. “We believe that future research is needed to address safety of attending physician sleep deprivation, especially in different specialties, for different procedures and also in nonteaching settings where there is less backup and support for the attending physician.”

Rothschild JM. JAMA. 2009;302:1565-1572.