Tuesday, March 1, 2011

Sleep Deprivation, Elective Surgical Procedures, and Informed Consent

There was an article in the December 30th edition of the New England Journal of Medicine about sleep-deprived surgeons. The authors propose that surgeons awake 22-24 hours be required by law to disclose that to patients about to undergo elective surgery so that the patient can reschedule if they want. Apparently, complication risk goes up 83% for elective surgeries when the surgeon has less than a six hour opportunity to sleep between procedures when on call the night before.

Organized medicine, such as the surgery specialty societies are not happy about this proposal. They feel that surgeons should be able to judge for themselves if they are capable of proceeding with an elective surgery. Also, telling a patient that you are "sleep-deprived" could set up a surgeon for a lawsuit. Surgeons fear that next they will be forced to reveal any financial or even marital problems they are having to their patients, because such personal problems could affect operating room performance.

Unfortunately, sleep deprivation decreases your ability to recognize if you are impaired from the sleep loss. Thus, one solution is educating surgeons (and all other medical specialties) how to recognize fatigue and how fatigue degrades cognitive and physical performance.

Already, the FAA restricts pilots from flying if they haven't had a certain number of hours of sleep. And residents (physicians in training) have their work hours limited to improve patient safety and reduce resident health problems.

I am not convinced federal regulation is the answer to sleep deprived surgeons, but I can see both sides of the argument. More data is needed and more education of all involved might a good first step.

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