Surgeons who are short on sleep should not be allowed to perform elective operations, unless they inform their patients of their drowsiness and get their written consent to operate, according to a paper in this week's New England Journal of Medicine.
Dr. Michael Nurok, lead author of the article on sleep deprivation and informed consent, told Â鶹´«Ã½ Channel that sleepy surgeons can put their patients at risk.
"It's unfair to expose patients to that risk … And we have increasing evidence that the risk is significant," he said.
Nurok, a New York anesthesiologist, said studies suggest that surgeons who operate in a sleep-deprived state have a higher-than-usual risk of patients with post-operative complications.
"When looking at procedures done when a surgeon has less than six hours of sleep, there's an increased risk of bleeding and organ damage," he said.
One recent study cited by the editorial suggests the risk may be as much as 83 per cent higher for surgical complications.
The three authors of the paper argue that because there are no rules governing the number of hours fully trained physicians can work in one shift, hospitals should create policies to minimize the likelihood of a sleepy surgeon performing a procedure.
Emergency procedures are an exception, since the benefits of even a sleep-deprived surgeon operating would outweigh the risks of not operating at all, according to the report.
Nurok said medical institutions should prohibit surgeons who have been on call all night from performing elective procedures the next day and should also make it easier to reschedule surgeries.
"This is a problem that can be avoided, so why put patients and surgeons in that position?" he said.
"We have data that show that sleep deprivation affects clinical performance, and we also have data that show that patients want to be informed if their surgeon didn't get enough sleep, so it's become a patient advocacy and safety issue."
Surgeons should also have to explain their sleep status to patients, the paper's authors argued, offering them the choice of either rescheduling the operation or choosing a different surgeon.
However, in an accompanying article the American College of Surgeons disagreed with the proposal and suggested instead that surgeons be allowed to keep track of their own state of drowsiness.
"We maintain that surgeons should be trained to identify and address this problem."
Nurok said that most people are poor judges of their own level of fatigue. "As with everybody, they could be impaired and not even be aware of it."
He acknowledged, however, that it could be difficult to enforce regulations against surgeons operating on too little sleep, in part because of the "culture of surgery" at most hospitals.
"The culture of surgery is to forge ahead and not complain about things like lack of sleep," Dr. David Cronin, an associate professor at the Medical College of Wisconsin in Milwaukee, told ABC News.
Complaining about lack of sleep "was looked down upon as ... a sign of weakness."
