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Ann Thorac Surg 2005;80:2420
© 2005 The Society of Thoracic Surgeons

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Correspondence

Sleep Deprivation and Results in Cardiac Surgery: Dangerous Study With Very Dangerous Conclusions

Cardiac Surgery Division, Regional Cardiac Center, Morriston Hospital, Swansea, SA6 6NL UK

(Email: ptotaro{at}yahoo.com).

To the Editor:

I read with interest the article by Ellman and co-authors [1] addressing the very important issue of a surgeon's working time restriction. In their article, Ellman and co-authors [1] wanted to demonstrate that sleep deprivation does not affect the performances of cardiac surgeons, and therefore that a restriction in the working hours for surgeons is not mandatory. To support their thesis, they also state that "...the surgeon's long hours working were what it took to become a skilled surgeon...." Furthermore they definitely do not agree to the "...pervading sentiment that the sleep-deprived surgeon should be eliminated..." I do believe that, although based on a correct statistical analysis, the conclusions of this study are very dangerous. I agree that "...the tired surgeon is a stereotype glamorised in books, television and movies....", but I think that the attempt to controvert (using a modern statistical analysis) the physiological evidence that any human being needs proper rest to perform at his best is really concerning. Surely some individuals need less sleep then others, and sometimes the incentives they could receive from a challenging situation could overwhelm any effect of sleep deprivation. To achieve optimal results, even if working in extreme circumstances is however a peculiar talent of few surgeons (and probably makes the differences between a good surgeon and a leading surgeon) and cannot be considered the standard for every surgeon.

Therefore, a regulated and restricted working time should only be considered as the way to avoid having doctors working in sleep deprivation circumstances rather than a barrier to become a skilled surgeon.

The scientific limitations of the study (such as the questionable definitions of sleep deprivation and surgical performances considered) have been clearly underlined in the discussion.

I would like to stress that the lack of restriction of a doctor's working hours (especially those in training) has eventually been recognized as an important matter. Relevant progresses have been achieved in Europe with the approval of the European Working Time Directive (EWTD), which clearly quotes the maximum working time for doctors in training.

Therefore, the final statement of this study that sleep deprivation does not affect operative results in cardiac surgery is very dangerous, because it could be used to contest the legitimacy of such an important achievement.

	References

Top References

 

1. Ellman PI, Law MG, Tache-Leon C, et al. Sleep deprivation does not affect operative results in cardiac surgery Ann Thorac Surg 2004;78:906-911.[Abstract/Free Full Text]

This article has been cited by other articles:

				I. L. Kron and P. I. Ellman Reply Ann. Thorac. Surg., December 1, 2005; 80(6): 2420 - 2421. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pasquale Totaro Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Totaro, P. Search for Related Content PubMed PubMed Citation Articles by Totaro, P. Related Collections Professional affairs Related Article