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• The effect of sleep deprivation on surgical skill can be measured
  oscar,m jolobe
  Published on: 7 June 2019

• Published on: 7 June 2019

  The effect of sleep deprivation on surgical skill can be measured

  • oscar,m jolobe, retired geriatrician manchester medical society

  A study performed in the United States lends support to the recommendations made by the European Working Time Directive regarding "ring fencing" of rest times for surgical trainees. In that study the effect of daytime sleepiness(measured on the Epworth Sleepiness Scale(ESS) was measured in 19 surgical trainees in otolaryngology-head and neck surgery programmes in 2 academic institution. ESS was documented, and surgical skill(in performig septoplasty) was evaluated by attending physicians using a global assessment tool and a skill-based visual analog scale. The attending physicians were unaware of the trainees' report on the ESS. Trainees, themselves, were also required to rate their own performance. The outcome was that , in regression analysis, there was a statistically significant inverse association between ESS scores and attending physician-rated technical skill both for the global assessment tool(p < 0.001), and for the visual analog scale(p=0.03)(1). Using both parameters the self-rated scores obtained by the trainees did not reach statistical significance(1). In other words, the trainees did not recognise the effect that daytime sleepiness was having on their surgical performance.
  The wider inference that can be drawn is as follows:-
  Daytime sleepiness impairs performance even though the trainee may be unaware of this adverse effect
  These observations are generalisable both to trainees and to consultant staff
  Consultan...

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  A study performed in the United States lends support to the recommendations made by the European Working Time Directive regarding "ring fencing" of rest times for surgical trainees. In that study the effect of daytime sleepiness(measured on the Epworth Sleepiness Scale(ESS) was measured in 19 surgical trainees in otolaryngology-head and neck surgery programmes in 2 academic institution. ESS was documented, and surgical skill(in performig septoplasty) was evaluated by attending physicians using a global assessment tool and a skill-based visual analog scale. The attending physicians were unaware of the trainees' report on the ESS. Trainees, themselves, were also required to rate their own performance. The outcome was that , in regression analysis, there was a statistically significant inverse association between ESS scores and attending physician-rated technical skill both for the global assessment tool(p < 0.001), and for the visual analog scale(p=0.03)(1). Using both parameters the self-rated scores obtained by the trainees did not reach statistical significance(1). In other words, the trainees did not recognise the effect that daytime sleepiness was having on their surgical performance.
  The wider inference that can be drawn is as follows:-
  Daytime sleepiness impairs performance even though the trainee may be unaware of this adverse effect
  These observations are generalisable both to trainees and to consultant staff
  Consultant surgeons(who are role models for trainees) who combine a gruelling NHS workload with "out of hours" private work are at risk of underperforming if they do not comply with the European Working Time Directive
  References
  (1)Tseng YW., Vedula S., Malpani A et al
  Association between surgical trainee daytime sleepiness and intraoperative technical skill when performing septoplasty
  JAMA Facial Plastic Surgery doi10.1001/amafacial.2018.117

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  Conflict of Interest:
  None declared.

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