Micko Alexander, Knopp Karoline, Knosp Engelbert, Wolfsberger Stefan
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
World Neurosurg. 2017 Oct;106:92-101. doi: 10.1016/j.wneu.2017.06.142. Epub 2017 Jun 30.
In times of the ubiquitous debate about doctors' working hour restrictions, it is still questionable if the physician's performance is impaired by high work load and long shifts. In this study, we evaluated the impact of sleep interruption on neurosurgical performance.
Ten medical students and 10 neurosurgical residents were tested on the virtual-reality simulator NeuroTouch by performing an identical microsurgical task, well rested (baseline test), and after sleep interruption at night (stress test). Deviation of total score, timing, and excessive force on tissue were evaluated. In addition, vital parameters and self-assessment were analyzed.
After sleep interruption, total performance score increased significantly (45.1 vs. 48.7, baseline vs. stress test, P = 0.048) while timing remained stable (10.1 vs. 10.4 minutes for baseline vs. stress test, P > 0.05) for both students and residents. Excessive force decreased in both groups during the stress test for the nondominant hand (P = 0.05). For the dominant hand, an increase of excessive force was encountered in the group of residents (P = 0.05). In contrast to their results, participants of both groups assessed their performance worse during the stress test.
In our study, we found an increase of neurosurgical simulator performance in neurosurgical residents and medical students under simulated night shift conditions. Further, microsurgical dexterity remained unchanged. Based on our results and the data in the available literature, we cannot confirm that working hour restrictions will have a positive effect on neurosurgical performance.
在关于医生工作时间限制的广泛辩论时期，高工作量和长时间轮班是否会损害医生的表现仍存在疑问。在本研究中，我们评估了睡眠中断对神经外科手术表现的影响。
10名医科学生和10名神经外科住院医师在虚拟现实模拟器NeuroTouch上进行相同的显微外科任务测试，一次是在充分休息后（基线测试），另一次是在夜间睡眠中断后（压力测试）。评估总分、时间控制和对组织施加的过度力量的偏差。此外，还分析了生命体征参数和自我评估。
睡眠中断后，无论是学生还是住院医师，总体表现得分均显著提高（基线测试与压力测试分别为45.1对48.7，P = 0.048），而时间控制保持稳定（基线测试与压力测试分别为10.1分钟对10.4分钟，P>0.05）。在压力测试中，非优势手组的过度力量在两组中均有所下降（P = 0.05）。对于优势手，住院医师组出现过度力量增加（P = 0.05）。与他们的结果相反，两组参与者在压力测试期间对自己表现的评估更差。
在我们的研究中，我们发现在模拟夜班条件下，神经外科住院医师和医科学生的神经外科模拟器表现有所提高。此外，显微外科操作的灵活性保持不变。基于我们的结果和现有文献中的数据，我们不能证实工作时间限制会对神经外科手术表现产生积极影响。
