Would you allow a sleepy surgeon operate on you? A narrative review

It is unclear if work-flow patterns resulting in sleep deprivation impacts on a surgeon's performance. Similar industries provide mitigating strategies to counteract sleep that may be of benefit to surgeons. A narrative review was conducted utilising Medline, Embase, Cinahl and Google Scholar. All English language papers including sleep and surgery and mitigating strategies for sleep deprivation in similar high-risk industries were included cumulating in 9050 non-duplicate papers. 97 studies were included in the final review. From this narrative review, it appears that there is a problem of sleep deprivation in the surgical profession. Results showed cognitive performance is more impacted than technical performance in the surgical profession in both simulated and real-life performance research. The relationship between sleep and workflow of surgeons is complex with numerous methodological approaches and contrasting research outcomes. Mitigating factors such as mandatory rest, simulation and stimulants have proven effective in other industries which parallel performance standards to surgery. This warrants a systematic review exploring the role of sleep deprivation and the potential role of mitigating interventions in areas of performance less understood like technical skill performance.