Extended Work Periods Among Anesthesiologists and Postoperative Patient Outcomes.

Area of Science:

• Anesthesiology and Perioperative Medicine
• Patient Safety Research
• Healthcare Workforce Studies

Background:

• Attending anesthesiologists lack work hour restrictions, raising concerns about fatigue-related patient harm.
• Prolonged work periods may impact vigilance and decision-making during surgical procedures.

Purpose of the Study:

• To investigate the association between extended anesthesiologist work periods (≥16 hours) and patient outcomes.
• To analyze the impact of fatigue on surgical outcomes and patient safety.

Main Methods:

• Cross-sectional study utilizing the Multicenter Perioperative Outcomes Group registry (2010-2020).
• Included over 1.6 million surgical procedures across 36 institutions.
• Compared outcomes for patients treated during anesthesiologist extended work periods versus standard work periods using a within-anesthesiologist approach, adjusting for confounders.

Main Results:

• The primary composite outcome (in-hospital mortality or major complication) did not show a statistically significant difference between extended and standard work periods (adjusted risk difference: 0.1%).
• Sensitivity analyses suggested a potential small increase (<1.0%) in the composite outcome risk.
• In-hospital mortality was slightly higher during extended work periods (1.3% vs 1.0%, P=.009).

Conclusions:

• While the primary analysis found no significant link, secondary findings suggest prolonged anesthesiologist work may be associated with a small increase in adverse patient outcomes.
• Further research is warranted to fully understand the implications of anesthesiologist fatigue on patient safety.
• These findings highlight the need to consider work hour policies for attending anesthesiologists.