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Surgeon Fatigue: A Prospective Analysis of the Incidence, Risk, and Intervals of Predicted Fatigure-Related Impairment in Residents

Frank McCormick, M.D.

A novel approach to identify at-risk periods among orthopedic surgical residents may direct fatigue risk mitigation and facilitate targeted interventions.

A prospective cohort study with a minimum 2-week continuous assessment period. Data on sleep and awake periods were processed using the sleep, activity, fatigue, and task effectiveness model.

Rotations at 2 academic tertiary care centers.

Twenty-seven of the 33 volunteer orthopedic surgical residents (82%) completed the study, representing 65% (33 of 51) of the orthopedic residency program.

Residents’ sleep and awake periods were continuously recorded via actigraphy, and a daily questionnaire was used to analyze mental fatigue.

Percentage of time at less than 80% mental effectiveness (correlating with an increased risk of err), percentage of time at less than 70% mental effectiveness (correlating with a blood alcohol level of 0.08%), the mean amount of daily sleep, and the relative risk of medical error compared with chance.

Residents were fatigued during 48% and impaired during 27% of their time awake. Among all residents, the mean amount of daily sleep was 5.3 hours. Overall, residents fatigue levels were predicated to increase the risk of medical error by 22% compared with well-rested historical control subjects. Night-float residents were more impaired (P=0.02), with an increased risk of medical error (P=0.045).

Resident fatigue is prevalent, pervasive, and variable. To guide targeted interventions, fatigue modeling can be conducted in hospitals to identify periods, rotations, and individuals at risk for medical error.