Can acute care surgeons perform while fatigued? An EAST multicenter study.

Area of Science:

• Surgical outcomes research
• Medical human factors

Background:

• Surgeon fatigue assessment has been limited to simulations or retrospective analysis.
• The impact of objectively assessed fatigue in acute care surgeons on patient outcomes remains unclear.

Purpose of the Study:

• To prospectively evaluate the effect of acute care surgeon fatigue on patient mortality and major morbidity.
• To determine if surgeon fatigue influences patient outcomes in emergency surgical cases.

Main Methods:

• Prospective study of emergency surgical cases over 27 months.
• Defined fatigued surgeons as those operating after midnight without prior sleep in 18 hours.
• Used hierarchical logistic regression to analyze fatigue's impact on mortality and morbidity, controlling for confounders.

Main Results:

• No significant difference in mortality (12.1% vs 12.1%) or major morbidity (46.9% vs 48.9%) between fatigued and rested surgeons.
• Surgeon fatigue did not independently affect patient outcomes after controlling for patient and center-level factors.
• Center-level variance in mortality and morbidity was observed (6.30% and 7.02%, respectively).

Conclusions:

• Acute care surgeon fatigue does not appear to affect patient outcomes.
• Work schedule adjustments for surgeons, such as shifts under 24 hours, are not warranted solely for improving patient outcomes based on this study.