Effect of sleep deprivation on the performance of simulated anterior segment surgical skill

doi:10.3129/i10-112

Canadian Journal of Ophthalmology

Volume 46, Issue 1, February 2011, Pages 61-65

https://doi.org/10.3129/i10-112 Get rights and content

Abstract

Objective: To measure the effect, using a computer simulator, of acute sleep deprivation on the performance of simulated anterior segment surgery skill.

Design: Prospective, non-randomized interventional study.

Participants: Nine ophthalmology residents (3 residents each from post-graduate years 2, 3, and 4).

Methods: Nine ophthalmology residents were tested on the Eyesi surgical simulator on 3 occasions; pre-callor rested (≥ 7 hours of sleep in previous 24 hours), post-work (8 hour work day and ≥ 7 hours sleep in previous 24 hours), and post-call or sleep-deprived (< 3 hours sleep in previous 24 hours). Residents were tested using the Eyesi forceps module and antitremor module. Level of sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Differences were compared using a 3-factor repeated-measure analysis of variance to account for multiple comparisons.

Results: Compared with pre-call and post-work, post-call residents had significantly less sleep in the previous 24 hours (p < 0.001) and were significantly sleepier when assessed using the ESS (p < 0.001). However, we detected no difference in technical performance using the antitremor module in pre-call (85 ± 21 points), post-work (80 ± 24 points), and post-call (81 ± 27 points; p = 0.51) residents or using the forceps module in pre-call (99 ± 1 points), post-work (98 ± 4 points), and post-call (98 \=- 5 points; p = 0.11) residents.

Conclusions: Acute sleep deprivation had no detectable impact on the performance of selected surgical task outcome measures when tested using the Eyesi surgical simulator.

Résumé

Objet: Mesure, avec simulateur électronique, de l’effet de la privation aiguë de sommeil sur la compétence dans la performance d’une chirurgie simulée du segment antérieur.

Nature: Étude prospective d’interventions non randomisées.

Participants: Neuf résidents en ophtalmologie (3 résidents par année post-graduée 2, 3 et 4 ans).

Méthodes: Neuf résidents en ophtalmologie ont subi le test du simulateur chirurgical Eyesi en 3 situations: avant appel ou repose (≥ 7 heures de sommeil dans les 24 heures précédentes), après travail (journée de 8 heures de travail et ≥ 7 heures de sommeil dans les 24 heures précédentes) et après appel ou privation de sommeil (< 3 heures de sommeil dans les 24 heures précédentes). Les résidents ont subi le test Eyesi avec module forceps et module anti-tremblement. Le niveau de somnolence a été évalué selon l’échelle de somnolence Epworth (ESS). Les différences ont été comparées à l’aide d’une analyse des variantes par mesures répétées de 3 facteurs pour prendre compte plusieurs comparaisons.

Résultats: Comparativement aux résidents avant appel ou après travail, les résidents après appel avaient significativement moins de sommeil dans les 24 heures antérieures (p< 0,001) et étaient significativement plus somnolents à l’évaluation avec l’ESS (p < 0,001). Toutefois, nous n’avons pas détecté de différence dans la performance technique en utilisant le module anti-tremblement chez les résidents avant appel (85 ± 21 points), après travail (80 ± 24 points) et après appel (81 ± 27 points; p = 0,51) ou en utilisant le module forceps chez les résidents avant appel (99 ± 1 points), après travail (98 ± 4 points) et après appel (98 ± 5 points; p = 0,11).

Conclusions: La privation aiguë de sommeil n’a pas d’impact détectable sur la mesure de la performance en regard des résultats des tâches chirurgicales choisies lors du test de simulation chirurgicale Eyesi.

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Citation Excerpt :
Sleep deprivation may result in a decrement in surgical performance of between 11.9% and 32% in studies available to perform effect sizes. Sixteen studies7–22 found a negative impact of sleep deprivation on technical skill performance, two studies23,24 found that sleep deprivation had a positive impact on performance, and fifteen studies25–39 found that sleep deprivation had no impact on performance. A key finding in the results indicated a 32% decrement in performance across 10 studies which found a negative impact of sleep deprivation on performance.
It is uncertain if sleep deprivation impacts sleepy surgeons’ technical skills. Lapses in surgical performance could increase morbidity and mortality. This review concludes if sleep deprivation impacts on technical skill performance in simulated environments.
Primary: 1. To identify if sleep deprivation has an impact on technical skill proficiency in surgeons. Secondary: a. To identify if the level of surgical experience, quality of sleep, or quantity of sleep influences technical skill proficiency in sleep deprived surgeons.
The review was conducted according to PRISMA guidelines utilising the databases Journals Ovid. Validation followed with two independent reviewers utilising an adapted version of BEME.
Thirty-three heterogeneous studies were included. Sleep deprivation likely negatively impacts technical performance between 11.9 and 32% decrement in performance. No strong evidence exists with regards to influence of experience, sleep type, or sleep length on technical proficiency.
Sleepy surgeons’ technical skills are, on balance, between 11.9 and 32% negatively impacted in a standardised simulated environment. This is likely to have clinical implications for patient safety.
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While statistically significant differences in reported sleep hours between pre-call (i.e., before a night shift) and post-call (i.e., after a night shift) participants have been noted, no difference in performance was found between the two grounds using the validated da Vinci skills simulator (dVSS) [35]. Similar findings have been found in literature surrounding learning of surgical skill in a sleep deprived state [12,19,36,37] as well as across various surgical fields include endoscopic simulation [38], ocular simulated surgery [39], ectopic pregnancy [40–42], ophthalmology [43] and laparoscopic cholecystectomy procedures [44]. A greater amount of studies have argued that there has been no significant change in real-life surgical performance among surgeons that are sleep deprived.
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Of 80 articles that were accessed, 7 were relevant for analysis. Fourteen relevant articles were identified from reference lists and were included in the analysis, for a total of 21 articles16,27-46 on sleep deprivation (Figure 5, Supplementary Table 5). Of the 21 studies that were analyzed, 12 studies with a total of 206 participants showed a statistically significant negative impact for sleep deprivation on surgical skills,16,27,30-32,35-38,41,45,46 and 9 studies with a total of 291 participants were neutral.28,29,33,34,39,40,42-44
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Effect of sleep deprivation on the performance of simulated anterior segment surgical skill

Abstract

Résumé

Am J Surg.

Lancet.

Am J Surg.

J Cataract Refract Surg.

J Cataract Refract Surg.

Effect of sleep deprivation on performance: a meta-analysis

Sleep.

A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale

Sleep.