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Médecine du travail du personnel hospitalier

Effects of fatigue on surgeon performance and surgical outcomes: a systematic review

Auteur     Lana Sturm
Auteur     Drew Dawson
Auteur     Richard Vaughan
Auteur     Peter Hewett
Auteur     Andrew G Hill
Auteur     John C Graham
Auteur     Guy J Maddern
Résumé     BACKGROUND Sleep deprivation and disturbances in circadian rhythms generally lead to poor performance, but is there a link in surgery? This review aimed to determine whether fatigue has an impact on surgeon performance or surgical outcomes. METHODS Studies were identified by searching EMBASE, CINAHL, PubMed, The Cochrane Library, Current Contents and clinical trials databases. Inclusion of relevant studies was by application of a predetermined protocol and independent assessment by two reviewers. Each included study was critically appraised for its study quality according to the methods used for Cochrane Reviews. Data from included studies were extracted by one researcher using standardized data extraction tables developed a priori and checked by a second researcher. RESULTS From 823 potentially relevant studies, a total of 16 studies were included in this review: two randomized controlled trials, five non-randomized comparative studies and nine case series. Of five studies that directly measure clinical performance, three studies reported no significant difference as a result of sleep deprivation, while two studies found increases in complications or errors. Eleven studies assessed psychomotor skill performance using a variety of simulation-based methods when a participant was rested and/or fatigued. Two randomized controlled trials reported no significant differences, while the nine remaining studies reported mixed results. Surgical residents with less surgical training/experience appeared to be more affected than more senior residents. CONCLUSION There is little evidence, as yet, to inform the issue of the effect of fatigue on surgical performance.
Publication     ANZ journal of surgery
Volume     81
Numéro     7-8
Pages     502-509
Date     2011 Jul-Aug

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