Impact of sleep deprivation on medium-term psychomotor and cognitive performance of surgeons: prospective cross-over study with a virtual surgery simulator and psychometric tests.

Background: Despite recent work hour restrictions, 24-hour calls remain an important part of patient care. The aim of this study was to assess the impact of 24-hour night calls on the psychomotor and cognitive skills of surgeons with a virtual surgery simulator (VSS) and psychometric tests. We hypothesized that sleep loss impairs surgical skills and concentration performance.

Methods: Seventeen surgery residents (test group) and 13 medical students (reference group) performed a 5-day training program on the VSS. The test group was then assessed during a night call on 4 test points (8 am and 4 pm on the on-call day, 8 am on the postcall day, and 8 am on the recovery day) to assess the effects of sleep loss on these surgery residents. The reference group performed the same tests but without a night call.

Results: The training resulted in a homogenous performance level for both groups. The average time for the test group was 26 minutes. The analysis between rested and sleep-deprived participants (6.5 +/- 0.9 vs 2.9 +/- 1.4 hours of night sleep) in the on-call part showed no performance differences. No impairment was found for the VSS and the cognitive tests within the test group between the start of the working day and the start of the postcall day after the night of relative sleep loss. The subgroup analysis showed no significant differences regarding the amount of night sleep and laparoscopic experience.

Conclusion: No performance impairment was found for surgeons with a VSS and standardized cognitive tests after a night of relative sleep loss. Although there is no doubt that sleep deprivation ultimately impairs human functioning, typical surgical skills do not necessarily deteriorate with a limited amount of sleep loss under clinical conditions.