Rothschild Jeffrey M, Keohane Carol A, Rogers Selwyn, Gardner Roxane, Lipsitz Stuart R, Salzberg Claudia A, Yu Tony, Yoon Catherine S, Williams Deborah H, Wien Matt F, Czeisler Charles A, Bates David W, Landrigan Christopher P
Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02120-1613, USA.
JAMA. 2009 Oct 14;302(14):1565-72. doi: 10.1001/jama.2009.1423.
CONTEXT: Few data exist on the relationships between experienced physicians' work hours and sleep, and patient safety. OBJECTIVE: To determine if sleep opportunities for attending surgeons and obstetricians/gynecologists are associated with the risk of complications. DESIGN, SETTING, AND PATIENTS: Matched retrospective cohort study of procedures performed from January 1999 through June 2008 by attending physicians (86 surgeons and 134 obstetricians/gynecologists) who had been in the hospital performing another procedure involving adult patients for at least part of the preceding night (12 am-6 am, postnighttime procedures). Sleep opportunity was calculated as the time between end of the overnight procedure and start of the first procedure the following day. Matched control procedures included as many as 5 procedures of the same type performed by the same physician on days without preceding overnight procedures. Complications were identified and classified by a blinded 3-step process that included administrative screening, medical record reviews, and clinician ratings. MAIN OUTCOME MEASURES: Rates of complications in postnighttime procedures as compared with controls; rates of complications in postnighttime procedures among physicians with more than 6-hour sleep opportunities vs those with sleep opportunities of 6 hours or less. RESULTS: A total of 919 surgical and 957 obstetrical postnighttime procedures were matched with 3552 and 3945 control procedures, respectively. Complications occurred in 101 postnighttime procedures (5.4%) and 365 control procedures (4.9%) (odds ratio, 1.09; 95% confidence interval [CI], 0.84-1.41). Complications occurred in 82 of 1317 postnighttime procedures with sleep opportunities of 6 hours or less (6.2%) vs 19 of 559 postnighttime procedures with sleep opportunities of more than 6 hours (3.4%) (odds ratio, 1.72; 95% CI, 1.02-2.89). Postnighttime procedures completed after working more than 12 hours (n = 958) compared with 12 hours or less (n = 918) had nonsignificantly higher complication rates (6.5% vs 4.3%; odds ratio, 1.47; 95% CI, 0.96-2.27). CONCLUSION: Overall, procedures performed the day after attending physicians worked overnight were not associated with significantly increased complication rates, although there was an increased rate of complications among postnighttime surgical procedures performed by physicians with sleep opportunities of less than 6 hours.
背景：关于经验丰富的医生工作时长与睡眠及患者安全之间的关系，现有数据较少。 目的：确定外科主治医师和妇产科医生的睡眠机会是否与并发症风险相关。 设计、地点和患者：对1999年1月至2008年6月期间由主治医师（86名外科医生和134名妇产科医生）实施的手术进行匹配的回顾性队列研究，这些医生在前一晚（凌晨12点至6点，夜间手术后的手术）至少部分时间在医院进行了另一台涉及成年患者的手术。睡眠机会计算为夜间手术结束至次日第一台手术开始之间的时间。匹配的对照手术包括同一位医生在没有前一晚夜间手术的日子里进行的多达5台同类型手术。并发症通过一个盲法三步流程进行识别和分类，该流程包括行政筛查、病历审查和临床医生评级。 主要观察指标：夜间手术后手术的并发症发生率与对照手术的比较；睡眠机会超过6小时的医生与睡眠机会为6小时或更少的医生在夜间手术后手术的并发症发生率。 结果：总共919例外科夜间手术后手术和957例产科夜间手术后手术分别与3552例和3945例对照手术匹配。101例夜间手术后手术（5.4%）和365例对照手术（4.9%）发生了并发症（优势比，1.09；95%置信区间[CI]，0.84 - 1.41）。睡眠机会为6小时或更少的1317例夜间手术后手术中有82例（6.2%）发生并发症，而睡眠机会超过6小时的559例夜间手术后手术中有19例（3.4%）发生并发症（优势比，1.72；95%CI，1.02 - 2.89）。工作超过12小时后完成的夜间手术后手术（n = 958）与12小时或更少（n = 918）相比，并发症发生率略高（6.5%对4.3%；优势比，1.47；95%CI，0.96 - 2.27）。 结论：总体而言，主治医师夜间工作后次日进行的手术与并发症发生率显著增加无关，尽管睡眠机会少于6小时的医生进行的夜间手术后外科手术并发症发生率有所增加。
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