Fatigue in Surgeons

Do patients who are operated on by a surgeon who has been awake at night have worse outcomes than those patients whose operation was carried out by a rested surgeon?

–Stop and guess the answer before reading on–

A recent paper [1] in the New England Journal of Medicine says no. The rate of some type of ‘complication’ was almost identical when the surgeon was tired or fresh – 22.2% versus 22.4% (P=0.66). The paper is a nice example of anonymous data-linkage. The study was based on all patients in the Canadian state of Ontario who underwent one of 12 major operations over a five year period. A specific fee code showed whether a given physician had attended patients between midnight and 07:00. In order to get rid of possible specific effects of physician/institution, type of procedure, or patient age, patients were matched on these factors. The statistical analysis then allowed for the clustering so created. Since, in general, fatigue is associated with diminished cognitive and manual performance, the results suggest that surgeons can compensate under the exigencies of the operating theatre. In his young days the CLAHRC WM Director often had to operate while fatigued, but did so with heightened arousal and vigilance.

— Richard Lilford, CLAHRC WM Director


  1. Govindarajan A, Urbach DR, Kumar M, et al. Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work. N Eng J Med. 2015; 373(9): 845-53.

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