Wake up call: Sleepy residents don't make worse surgeons, study says

Tired surgery residents aren't worse surgeons than their better-rested peers, according to a study published in the Journal of Surgical Research.

This finding, based on a review of the outcomes of 2,900 laparoscopic cholecystectomies, which involve removing the gall bladder, and 1,700 appendectomies performed by residents between July 2003 and March 2009, contradicts the commonly held assumption that fatigued and overworked residents can pose a safety threat to patients.

The researchers compared surgery results--including complication rates, conversion to open operation, length of surgery, and mortality--from the first 16 hours of a physician's shift with those performed in the last eight hours of a typical 24-hour shift, when residents would likely be more exhausted. The outcomes came from County Harbor-UCLA Medical Center.

The revelation chips away at the underlying assumptions behind the Accreditation Council for Graduate Medical Education's recent proposal [1] that first year residents' work hours be cut from 24 to 16 hours and the Institute of Medicine's recent recommendation that on-call residents be allowed five hours of rest time after 16 hours of work.

"The rationale is that this [new requirement] would intuitively lead to better-rested medical residents who would take care of patients more safely," Dr. Christian de Virgilio, a study co-author and researcher at Los Angeles Biomedical Research Institute, told the Daily Breeze. "We haven't seen that that's necessarily the case."

The study suggests that limiting resident shifts to 16 hours of work is unlikely to improve surgical outcomes for the two most commonly performed surgeries, de Virgilio told Physorg.com. He opposes cutting the hours per day a resident may be available for surgical training, because they could miss out on critical aspects of a patient's care. Plus, it would increase the costs and length of surgical training, which can take 10 to 15 years.

To learn more:
- see the abstract [2] in the Journal of Surgical Research
- see the New England Journal of Medicine abstract
[1]- read the Daily Breeze article
[1]- check out the Physorg.com [1]article [3]

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Hourly limits for surgical residents in Switzerland negatively impact training, patient safety [5]
Study: Residents work too many hours [6]