Late shifts don't hurt doctors' surgical outcomes

Surgical outcomes are equally safe when performed by surgeons who worked a late shift the night before as those who didn't work late, according to a new study published in the New England Journal of Medicine.

Researchers analyzed outcomes for 12 procedures among 37,978 patients and 1,448 physicians, comparing outcomes for patients whose surgeons worked the midnight to 7 a.m. shift the night before to those whose surgeons did not. They found mortality rates of 22.2 percent for those whose surgeons had worked the graveyard shift, compared to 22.4 percent to those who did not, and a similar lack of difference after controlling for academic versus nonacademic facilities, procedure type or surgeon age.

The study backs up a 2013 study finding sleep deprivation among surgeons did not affect outcomes.

However, the study was hindered by the fact that researchers did not account for surgeons' actual amounts of sleep, Charles Czeisler, chief of the division of sleep and circadian disorders at Brigham and Women's Hospital, told Reuters Health. Czeisler was part of a study in 2009 published in the Journal of the American Medical Association that found lack of sleep leads to more mistakes. 

"Given the increased risk that we've seen with just one night of insufficient sleep, patients have the right to know if their doctor has been awake for one night, two nights or even three consecutive nights," he said.

However, the NEJM study noted that that previous research focused on medical residents' outcomes. Attending physicians have far more schedule flexibility, Nancy Baxter, lead author of the NEJM study, told Kaiser Health News, and can schedule longer breaks between night shifts. Furthermore, she told Reuters, the JAMA study had a far smaller sample size and was conducted in a single institution.

In 2011, the Accreditation Council for Graduate Medical Education imposed a ceiling on resident work hours, but a 2015 study found no subsequent improvement in patient safety, FierceHealthcare previously reported.

To learn more:
- read the study abstract
- check out the KHN article
- here's the Reuters article