Elsevier

World Neurosurgery

Volume 106, October 2017, Pages 92-101
World Neurosurgery

Original Article
Microsurgical Performance After Sleep Interruption: A NeuroTouch Simulator Study

https://doi.org/10.1016/j.wneu.2017.06.142Get rights and content

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

Introduction

Stress is part of our everyday life and affects us more than we consciously notice. In the medical profession, personnel are confronted with high work load and responsibility. surgeons in particular claim to work under immense pressure and stressful conditions,1, 2 which was shown to result in high burnout rates among surgeons.3, 4 Overtime and night shifts cause an additive important stressor by frequent interruption of sleep periods.5, 6

Sleep interruption and deprivation have a vast impact on attention and concentration,7, 8, 9, 10 decision making,11, 12, 13 cognition,13, 14 and psychomotor skills.14, 15, 16, 17, 18, 19, 20

In the United States, because of court recommendations, working hours of interns and residents were limited to a maximum of 80 hours per week and daily duty to a maximum 16 consecutive hours.21 In 2003, the European Union introduced a new labor law to prevent medical errors related to occupational stress and fatigue. The maximal working hours were restricted to 48 hours a week on average and 11 consecutive resting hours per 24-hour period.22

In a recent study,23 it was seen that stress level increased in all surgeons while they were performing acute surgery, regardless on the level of training. However, junior doctors experienced significantly more stress compared with senior surgeons. Bajunaid et al.24 showed that initiated acute stress on the neurosurgical simulator NeuroTouch (National Research Council, Boucherville, Quebec, Canada) significantly decreases performance during an acute stressful episode but the same effect could not been found in the post-stress operative performance.

However, it is still controversial how fatigue by sleep interruption and sleep deprivation affect surgical performance,25, 26, 27 with most studies having been reported in general surgery. To the best of our knowledge, the impact of sleep interruption on neurosurgical procedures has not been examined.

The current study was designed to evaluate the effects of sleep interruption on the microsurgical performance of medical students and neurosurgical residents. The virtual-reality simulator NeuroTouch, which is one of the most realistic simulators for neurosurgery, has been used to evaluate performance changes after sleep interruption.

The aim was to create a scenario that is realistic in terms of both surgical performance and night shift conditions without placing patients at risk. We hypothesized that sleep interruption has negative effects on neurosurgical simulator performance.

Section snippets

Methods

For this prospective cohort study, we recruited 10 medical students (group S) with an interest in neurosurgery from the Medical University of Vienna.

The second group consisted of 10 residents (group R) currently in training (5 junior residents, postgraduate year 1–3; 5 senior residents, postgraduate year 4–6) at the Department of Neurosurgery. During the enrolment, working hours were limited to a maximum of 72 hours per week by local regulatory agency.

The current study was approved by

Results

To evaluate the effects of sleep interruption on neurosurgical simulator performance of medical students (group S) and neurosurgical residents (group R), we compared performance values between baseline and stress test overall and between study groups.

Second, the data surveyed in the questionnaire were put in context with performance values.

Discussion

Pursuing the hypothesis that microsurgical performance may decline after sleep interruption, we investigated this effect by simulating night-shift conditions using the NeuroTouch simulator.

Conclusions

Sleep interruption and stress are common among surgical residents, especially in neurosurgery, and concern about fatigue-related errors in medicine has been broadly discussed in recent years. 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

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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