Black cloud in digestive surgery: Myth or reality?

Digestive surgery is known to be a surgical specialty with high workload, through training program for residents and lot of emergent procedures during night shift. The term "black cloud" referred to nurses, attending physicians and residents who seem to have a heavier workload during on-call shifts relative to their peers. The scientific literature is controversial about the reality of this concept. The aim was to determine if the "black cloud" concept really exists in digestive surgery.

All the emergent surgeries (under general and local anaesthesia) performed in one department of digestive surgery in a tertiary referral centre (Timone Hospital, Marseille, France) were prospectively included during 6 months.

During the study period, 423 emergent digestive procedures were performed in one tertiary referral centre, by 9 surgeons and 8 residents. The mean number of interventions was similar between surgeons (P=0.4). Regarding the surgeon degree, the mean number of emergent procedures was similar between attending surgeons and senior residents (2.3±1.5 vs 2.4±1.6, P=0.49). There was no significant difference between digestive surgery residents and those from urology and gynaecology training program in terms of mean number of emergent procedures (2.2±1.5 vs 2.4±1.6, P=0.4). The emergent procedures performed during the day were significantly different between weekdays (P=0.03), with a lower number of procedures performed on Sunday: 0.9±0.9 [range, 0-3].

We did not identify a real "black cloud" in our digestive surgery department. We only reported that there were less emergencies procedures during the day of Sunday.