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Meta-Analysis
. 2018 Sep 21;8(9):e021967.
doi: 10.1136/bmjopen-2018-021967.

Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review

Affiliations
Meta-Analysis

Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review

Michelle Gates et al. BMJ Open. .

Abstract

Objectives: For physicians in independent practice, we synthesised evidence on the (1) impacts of insufficient sleep and fatigue on health and performance, and patient safety and (2) effectiveness of interventions targeting insufficient sleep and fatigue.

Design: We systematically reviewed online literature. After piloting, one reviewer selected studies by title and abstract; full texts were then reviewed in duplicate. One reviewer extracted data; another verified a random 10% sample. Two reviewers assessed risk of bias. We pooled findings via meta-analysis when appropriate or narratively.

Data sources: We searched Medline, Embase, PsycINFO, CINAHL and PubMed for published studies in April 2016; Medline was updated in November 2017. We searched Embase for conference proceedings, and hand-searched meeting abstracts, association and foundation websites.

Eligibility criteria for selecting studies: English or French language primary research studies published from 2000 to 2017 examining the effect of fatigue-related or sleep-related exposures or interventions on any outcome among physicians in independent practice and their patients.

Results: Of 16 154 records identified, we included 47 quantitative studies of variable quality. 28 studies showed associations between fatigue or insufficient sleep and physician health and well-being outcomes. 21 studies showed no association with surgical performance, and mixed findings for psychomotor performance, work performance and medical errors. We pooled data from six cohort studies for patient outcomes. For sleep deprived versus non-sleep deprived surgeons, we found no difference in patient mortality (n=60 436, relative risk (RR) 0.98, 95% CI 0.84 to 1.15, I2=0% (p=0.87)) nor postoperative complications (n=60 201, RR 0.99, 95% CI 0.95 to 1.03, I2=0% (p=0.45)). The findings for intraoperative complications and length of stay were considerably heterogeneous.

Conclusions: Fatigue and insufficient sleep may be associated with negative physician health outcomes. Current evidence is inadequate to inform practice recommendations.

Keywords: risk management; sleep medicine.

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Conflict of interest statement

Competing interests: CSi is employed by the Canadian Medical Association, who provided financial support for the research.

Figures

Figure 1
Figure 1
Flow of records through the selection process.
Figure 2
Figure 2
Forest plot for operating time among sleep deprived and non-sleep deprived surgeons.
Figure 3
Figure 3
Forest plot for postoperative complications among surgeries performed by sleep deprived and non-sleep deprived surgeons. Vinden et al77 reported iatrogenic injuries, Schieman et al63, Govindarajan et al and Chu et al reported postoperative complication rate and Ellman reported postoperative complications (other types of complications reported not included in the analysis).
Figure 4
Figure 4
Forest plot for patient mortality among surgeries performed by sleep deprived and non-sleep deprived surgeons.

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