A Pilot Study Examining Sleep Deprivation Among Liver Transplant Surgeons. Are Patient Outcomes at Risk?

Area of Science:

• Transplant Surgery
• Surgical Outcomes
• Physiology

Background:

• Transplant surgery presents unique challenges including irregular schedules and high stress.
• The impact of surgeon sleep deprivation and stress on liver transplant (LT) recipient outcomes is not well understood.
• Cognitive function is known to be affected by sleep deprivation and stress.

Purpose of the Study:

• To investigate the relationship between surgeon sleep deprivation, stress levels, and liver transplant (LT) recipient outcomes.
• To utilize continuous wearable biophysical monitors for objective measurement of surgeon physiological states.
• To assess the feasibility of monitoring surgeon sleep and stress in a high-volume transplant center.

Main Methods:

• Attending LT surgeons at a high-volume center wore biophysical monitors for 5 months.
• Surgeon sleep deprivation and stress levels were prospectively measured.
• LT recipient outcomes were reviewed up to 90 days post-transplant.

Main Results:

• Fifty percent of primary surgeons experienced sleep deprivation during LT.
• Moderate-to-high stress levels were recorded in 94.4% of cases.
• Surgeons experiencing sleep deprivation had higher intraoperative blood product use and increased bile leak rates within 90 days; sleep deprivation was a significant predictor of bile leak.

Conclusions:

• This is the first study to use continuous wearable monitors to assess surgeon sleep deprivation and its impact on LT outcomes.
• Despite high rates of surgeon sleep deprivation and stress, patient outcomes were largely similar.
• Bile leak was significantly associated with surgeon sleep deprivation, highlighting a critical area for future research and intervention.