Surgery and Sleep Deprivation

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Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 2/7/2011 6:59 PM (GMT -6)   
New England Journal of Medicine, December 30, 2010 (N ENGL J MED 363;27)

Very interesting document regarding sleep deprivation and scheduled elective surgery.  It is an easy read and only 3 pages long.  Of interest to me was the following statement; “In surgery, there is an 83% increase in the risk of compilations (e.g., massive hemorrhage, organ injury, or wound failure) in patients who undergo elective daytime surgical procedures performed by attending surgeons who had less than 6-hour opportunity for sleep between procedures during a previous on-call night.   The reference sited for that statement was (Rothschild J M, Keoheane C A, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures JAMA 2009.
A 2008 study was sited for this next statement; “Sleep deprivation adversely affects clinical performance and impairs psychomotor performance as severely as alcohol intoxication”.
 
The Journal continues, “As a first step, we recommend that institutions implement policies to minimize the likelihood of sleep deprivation before a clinician performs elective surgery and to facilitate priority rescheduling of elective procedures when a clinician is sleep-deprived. 
Sleep deprivation could be due to the loss of sleep because of a chronic problem, or repeated interruption, ( calls from the residents, or perhaps a sick spouse or child). How would you know if the surgeon that you have chosen for this job has had a sleepless night.?  The question is that given the above information from the New England Journal of Medicine, would you make it a condition of the informed consent that the physician disclose to you immediately preoperative if he or she had less than (you pick the number)  hours of sleep prior to performing a major surgery? Or is this a non-issue to you?
 
I’d be interested in thoughts and comments about this...
 
I have always found it interesting here on HW about the minimal number of surgeries needed, as perceived by the individual, before someone is considered “skilled enough to operate on me”. That number ranges from just a few... to a gazillion.  However; it would appear that it is as important, to established that the surgeon isn’t tootered or sleep deprived, regardless of the number. 
Hero
Age 51 PSA 6.8
Bxy 10 of 12 Cores positive for Gleason 6. up to 75%
Robotic surg 11-02-09
Post op path. 20% neoplasm;4+3=7 Gleason
All nodes (14) and other related tissue negative for cancer
No EPE
Post op PSA x 3, all <0.01
walkbobwithjack.blogspot.com

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3984
   Posted 2/7/2011 7:25 PM (GMT -6)   
another thing to worry about.  i read the other day that an airline pilot was in a deep sleep while flying.
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 2/7/2011 7:26 PM (GMT -6)   
Hi Hero, really interesting!

Obviously, a sleeply genius isn't great. But, better than an average surgeon who is alert and at the top of their game?

For me it is just further evidence that a focus on the number of surgeries performed, rather than quality of surgeries performed, is a danger. The root cause is likely that, as lay people, we can ask about number of surgeries, but to really do due diligence is difficult, if not impossible, and seeing through a mirror darkly is better than not seeing at all.

My concern is always that the emphatic advice sometimes given here about surgery numbers as being so critical will mislead newcomers into thinking that once they know that number, they've got all the key information they need, rather than thinking it's an interesting number, and a worthwhile thing to know, but NOT the question their own doctor would be putting significant weight on if they were the one headed for a RP. They'd be interested in results, measured by everything from time spent under general anesthetic, to post surgical complications, to pathology margins, etc. etc. etc.

One thing I've got on my list to ask about now is whether or not the surgeon is, as you so delightfully put it, "tootered."

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/7/2011 7:34 PM (GMT -6)   
This is why I wouldn't want to have surgery where the surgeries are stacked up like cord wood, and the surgeon rushes from one OR to the next. That's a good thing about living in a smaller area.

With both my major surgeries in the last 2 years, my surgery was the only one on my surgeon's plate that day, the only show of the day for him.

Don't think we need a new subject to worry about, next we will be advising our doctors about proper sleep habits, lol.

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 2/8/2011 11:11 AM (GMT -6)   

Purg,

You are a better man than I am.  I doubt I could be as supportive as you are of doctors in a "smaller area" if I had experienced what happened to you over the past few years.  I don't think I would still be able to say - to use your words - "i am compliant to my doctors, their advice, and their orders."

In any event, flip this thread around.  What is the effect of a patient's lack of sleep the night before major surgery?  I have had seven surgeries in the past few years, and anxiety and stress didn't make for a good night's sleep before any of them.  How does that factor in to the issue of how a patient's body responds to the physical stresses of surgery, particularly unforeseen stresses that arise during emergencies? 

For that matter, most people find it practically impossible to get a good night's sleep in a hospital after surgery.  How does that affect healing?

Zen9


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4848
   Posted 2/8/2011 11:30 AM (GMT -6)   
And we don't want our surgeons to:
 
Fight with their spouce.
Attend a furneral of a child of theirs that died a few days ago.
Should have stopped drinking on the 4 hole at the golf course yesterday.
The list just goes on and on.
 
 
Maybe someday robotic surgery will be done by robots instead of humans.
 

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2217
   Posted 2/8/2011 11:45 AM (GMT -6)   
Don't these stats relate to ALL surgery and not just Da Vincis. Uro's surely aren't scheduling a robot op at midnight are they. Mine did/does one at about 7am and another at about 11am.

In the army my dad operated non-stop for 72 hours while under bombardment. But I don't think he would have wanted to di that every week!!!

Alf

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/8/2011 11:53 AM (GMT -6)   
zen, let's break this down to reality.

same surgeon did all 8 of mine. the open surgeon went well, the complications were because of my body, and the BCR? do you automatically blame the surgeon for that? I think not. The 6 corrective surgeries were done correctly, but its not the surgeons fault the patient has severe scarring issues that made each of them ultimately a failure. And my last big surgery, to do the urostomy, went text book perfect, and the results, though still healing, are what we hoped for and expected. I sense a lot of the "blame the doctor" game here in your remarks.

david

now the lack of sleep on the patient's side, that i understand. my last one had me in the hospital for 5 1/2 days, and i barely ever slept more than an hour at the time, always interupted sleep, day and night
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

wigged-out
Regular Member


Date Joined Dec 2009
Total Posts : 130
   Posted 2/8/2011 4:59 PM (GMT -6)   
Well, I kinda asked what day my surgeon would be "at his best" and his nurse half jokingly mentioned Monday AM was good.

I just hope that my dude wasn't having some fun-lovin' drunken Caligula-like party the Sunday before.... shocked

I suppose by the end of next Monday I'll know for sure.
Age: 55- good health. Exercise regularly.
DRE 11/08- no lumps, just enlarged prostate
PSA checked regularly, last 6.6/
Needle Biopsy 11/09- 12 samples. 11 OK. Right Lateral Mid- Adenocarcinoma Gleason score 3+3=6 9 involving 5% of specimen.
PSA risingto 8.0 thru 2010.
2nd biopsy- 2 positive cores, one a 3+3=6, 3% and the other a 3+4=7, 20%
Very last PSA- 12
DaVinci scheduled 2/14/2011

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 2/8/2011 7:23 PM (GMT -6)   
wigged-out --- I went with a Monday and it worked like a charm. I was first on the slate and the scalpels were all fresh for the week, and the rest of the instuments had been sterilized on the weekend, all set for the week --- what more could I ask for?

Well, one thing. As I looked at the da Vinci machine sitting there at the end of the table I realized it was also used for hysterectomies and my last thought as I went to ga-ga land was: "I sure hope whoever loaded the softwear this morning got the right program ......"

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 2/9/2011 9:22 AM (GMT -6)   
My surgeon called me at home (~8:00 Monday evening) the night before the surgery, to make sure I was ok and if I had any other questions.
I don't know if he went out drinking after calling me but it was comforting to know he was most likely at home and at least thinking about where his hands would be 11 hours later. I was first up to the plate. He did two other guys the same day.

(It was also comforting for me to know he was married with 2 kids around 10 years old.)

Fairly or unfairly, I don't want my surgeon to be a single, party boy with HOTDOC custom license plates on his BigMoneyWaster M6.

Jeff

How many of us would appreciate the pre-surgery call. Should it be mandatory?

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4848
   Posted 2/9/2011 9:29 AM (GMT -6)   
My surgeon gave me his cell number after taking the cath ...which had been in for five weeks.  The plan was for me to call him before heading the ER should trip be necessary. Luckily it wasn't.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7078
   Posted 2/9/2011 3:32 PM (GMT -6)   
I was pretty much sleep deprived on the day I went in for surgery. Probably hadn't had two hours sleep any night for the months since diagnosis. Everyone tells about seeing the robot - I was hard cold out before I was out the door of the prep area. I did not see the robot -
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