The Effects of Mental Fatigue on Surgical Performance:A Systematic Review

Introduction: The effect of mental fatigue and sleep deprivation on surgeons has been questioned for decades. While other high-stake professions such as aviation and military have already established guidelines to restrict work hours, this trend has yet to reach the surgical profession. This study aimed to give a complete and up-to-date overview of the existing literature regarding the impact of mental fatigue on surgical performance, in order to facilitate further research and the development of guidelines. Methods: A systematic review was performed searching Medline and Embase. 31 studies regarding the relation between fatigue and surgical performance, using both real-life surgery and simulator studies, were included. Articles based on patients as well as on surgeons and surgical residents were included. Articles based on stress, muscle fatigue, learning, work hour restrictions or regulations were excluded from analysis, as were studies on medical students and non-surgical professions. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. The studies were analyzed using descriptive statistics. Results: None of the studies on real-life surgery found a correlation between fatigue and surgical performance, but 45% of simulator studies found a negative correlation between fatigue and surgical performance, and 22% of simulator studies found a positive correlation. 8% of surgeon-based studies found a negative correlation, while 44,5% of intern-based studies did. Conclusion: In simulator studies, the effects of fatigue were mixed, but in real-life surgery, fatigue appears not to affect surgical performance. An explanation for this difference between simulator and real-life studies may lie in the fact that in real-life operations the stakes are higher and surgeons put in more effort to protect their performance against the detrimental effects of fatigue. However, surgical performance measures in real life operations were found to be rather crude, so it is unclear whether these measures were sufficiently sensitive to detect effects of fatigue if they do exist. We argue for more fine-grained performance measures in future research. Disclosure: Nothing to disclos