Fatigued Surgical Residents May Increase Risk of Surgical Errors

Modern surgical techniques have enabled doctors to successfully treat conditions that would once have been life-threatening. But for all their skill, surgeons are human and they do make mistakes. Unfortunately, a new study indicates that some surgical mistakes occur due to circumstances that may be preventable.

According to a small study conducted at two Boston area hospitals, surgeons in training are often tired enough to significantly increase their risk of making errors in the operating room. Researchers discovered that surgical residents were getting only five and a half hours of sleep on average - so little sleep that their impairment during waking hours was the equivalent of being legally drunk.

While the size of the study was limited, the implications are alarming. Nevertheless, the lead author of the study, Dr. Frank McCormick of the Harvard Combined Orthopaedic Residency Program in Boston, cautions that the study's estimates of risk for surgical errors were predictions based on the fatigue level of residents. The study did not track the actual incidence of surgical error.

Fatigue has long been recognized as a problem for surgical residents. In fact, last year, the Accreditation Council for Graduate Medical Education, which oversees resident training, enacted new rules stating that new residents should not work for more than 16 hours at a time. More experienced residents, however, are still allowed to work up to 28 hours straight.

The findings of Dr. McCormick's study may force residency programs to make difficult budget choices. The Institute of Medicine estimates that limiting the number of hours residents can work at a given time would cost hospitals approximately $1.7 billion, mostly due to hiring more staff. Though other options may be as effective - for example, implementing monitoring programs to ensure that overly tired residents do not enter operating rooms - it seems likely that hospitals may need to spend more to increase safety.

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