Z. C. Bernhard1,2, T. W. Wolff1,3, B. L. Lisjak1, I. Catanescu1, E. Baughman1,4, M. L. Moorman1,4, M. C. Spalding1,4 1OhioHealth Grant Medical Center,Division Of Trauma And Acute Care Surgery,Columbus, OHIO, USA 2West Virginia School of Osteopathic Medicine,Lewisburg, WEST VIRGINIA, USA 3OhioHealth Doctors Hospital,Department Of Surgery,Columbus, OHIO, USA 4Ohio University Heritage College of Osteopathic Medicine,Athens, OHIO, USA
Introduction: Mental fatigue is a psychobiological state caused by prolonged periods of demanding cognitive activity. For over 20 years, the relationship between mental fatigue and physical performance has been extensively researched by the US military, the transportation industry, and other high-risk occupations. This is a growing area of interest within the medical community, yet there remain relatively few investigations specifically pertaining to surgeons. This study sought to quantify and evaluate fatigue and recovery time following 24-hour call among trauma surgeons to serve as a starting point in optimizing staffing and scheduling. We expected more sleep both during and after call, prior to the next normal circadian sleep cycle, would lead to faster recovery times.
Methods: This was a prospective analysis of trauma surgeons employed at an urban, Level 1 trauma center. Readiband actigraphy monitors (FatigueScience, Vancouver, BC) incorporating a validated Sleep, Activity, Fatigue, and Task Effectiveness Model, were used to track sleep/wake cycles over a 30-day period. Recovery time was measured as the time required during the post-call period for the surgeon to return to his/her pre-call 24-hour mean alertness level. Three groupings were identified based on recovery time: rapid (0-6 hours), intermediate (6-18 hours), and extended (>18 hours). Tri-linear regression analysis was performed to assess correlation between recovery time and on-call, post-call, and combined sleep quantities.
Results: Twenty-seven 24-hour call shifts among 8 trauma surgeons (6 males, 2 females) were identified and analyzed. Mean age was 41.0 ± 5.66. Mean work hours per week was 54.7 ± 13.5, mean caffeinated drinks per day was 3.19 ± 1.90, and mean hours of exercise per week was 4.0 ± 2.5. Six call shifts met rapid criteria, 11 shifts intermediate, and 10 shifts extended, with mean recovery times of 0.49 ± 0.68, 8.86 ± 2.32, and 24.93 ± 7.36 hours, respectively. Table 1 shows the mean alertness levels and sleep quantities for each group. Statistically significant and moderate positive correlations were found between recovery time and the amount of sleep achieved on-call (p=0.0001; R2=0.49), post-call (p=0.0013; R2=0.49) and combined (p<0.0001; R2=0.48).
Conclusion: This early analysis indicates that increased sleep quantities achieved on-call, post-call, and combined are partially indicative of quicker recovery time in surgeons following 24-hour call shifts, thus serving as a viable starting point to optimize trauma surgeon staffing and scheduling. Further studies to validate these findings and evaluate the impact of additional sleep components, such as number of awakenings, should be undertaken.
