Sleep Deprivation Does Not Disturb Interventionist Performance
A single-center study found that percutaneous coronary intervention
(PCI) procedures performed during the middle of the night do not
adversely affect the safety and effectiveness of procedures performed
the next day by the same operator. Findings now available in Catheterization
and Cardiovascular Interventions, a journal published by
Wiley-Blackwell on behalf of The Society for Cardiovascular Angiography
and Interventions (SCAI), show late night work while on call does not
worsen performance of the interventionist doing PCIs the next day.
Studies have shown that sleep deprivation in medical personnel may
increase the risk of serious medical errors, percutaneous injuries and
motor vehicle accidents. Moreover, previous research has reported higher
complication and failure rates for PCIs performed after regular working
hours. However, to date no study has provided evidence of operator
fatigue on the success and complication rates of PCI procedures. Each
year more than one million PCI procedures, commonly known as
angioplasty, are performed in the U.S. according to the National Heart,
Lung, and Blood Institute.
For the present study, Vitalie Crudu, MD, and colleagues from Geisinger
Medical Center in Danville, Pa., identified PCIs performed at the center
from January 1, 2005 through December 31, 2009 between 11 p.m. and 7
a.m. PCIs performed during the following work day by the same
interventionist were compared to PCI’s performed by interventionists not
on call the night before.
The team reported 3,944 PCIs were performed by four operators during the
five-year period, which included 167 PCIs performed by operators after
late night work while on call. The overall incidence of complications
were similar in the PCIs done by operators working the night before
compared with PCIs done by rested physicians. Types of complications
identified as potentially more sensitive to operator error or judgement
occurred with similar frequency in both groups. The post-call physician
PCIs had 1.2% intra-procedural deaths compared to 0.2% in the rested
physician group, a difference that was not statistically significant.
Researchers reported more frequent excessive bleeding at the access site
in the rested versus post-call PCIs at 2.7% and 0%, respectively.
“Our investigation found no evidence that middle-of-the-night PCIs
adversely affect safety or efficacy of procedures performed the
subsequent day by the same interventionist,” concludes Dr. Crudu.
“Further study with larger a larger number of cases is necessary to
identify any warning signals of correlations between sleep deprivation
and PCI outcomes.” In the interim, the authors suggest that
sleep-deprived interventionists could minimize risk by deferring
emergency cases to rested colleagues and avoiding elective high risk
PCIs while fatigued.
