Surgeon fatigue does not affect surgical outcomes: a systematic review and meta-analysis

Purpose To systematically review the effects of surgeon fatigue on postoperative mortality and postoperative complications after elective and non-elective surgeries. Methods A database search was conducted for original articles published in PubMed between 2000 and 2020 with the keywords: “surgeon,” “sleep deprivation,” “sleep deprived,” “fatigued,” “mortality,” “morbidity,” and “outcomes.” We selected articles that disclosed actual numbers of patients who underwent surgery by fatigued or rested surgeons, rates of postoperative mortality, or total postoperative complications. Results Of the 1427 articles identified, 16 met the selection criteria and were included. Eight of the 16 also included total postoperative complications. Analysis revealed no significant differences in the rates of postoperative mortality after elective and non-elective surgeries or total postoperative complications of elective surgeries or non-elective surgeries performed by fatigued vs. rested surgeons. The relative risks were 1.03 [95% confidence interval (CI), 0.86–1.24], 1.08 (95% CI, 0.85–1.38), 0.99 (95% CI, 0.95–1.04), and 0.93 (95% CI, 0.67–1.28), respectively. Conclusion Surgeon fatigue does not affect the rates of postoperative mortality or total postoperative complications after elective surgeries and may have little to no effect on the rates of postoperative mortality or total postoperative complications after non-elective surgeries.