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CAGS and ACS evidence based reviews in surgery. Risks of complications by attending physicians after performing nighttime procedures.

Objective: To determine whether sleep opportunities for attending surgeons and obstetricians/gynecologists are associated with the risk of complications. Design: Matched retrospective cohort study of procedures performed from 1999 to 2008 by attending physicians (86 surgeons, 134 obstetricians/gynecologists) who had been in hospital performing another procedure in adult patients for at least part of the preceding night (12:00–6:00 am postnighttime procedures). Results: A total of 9191 surgical and 957 obstetrical postnighttime procedures were matched with 3552 and 3945 control procedures, respectively. Complications occurred in 101 postnighttime procedures (5.4%) and 365 control procedures (4.9%; odds ratio [OR] 1.09, 95% confidence interval [CI] 0.84–1.41). Complications occurred in 82 of 1317 (6.2%) postnighttime procedures performed by surgeons who had 6 hours of sleep or fewer versus 19 of 559 (3.4%) postnighttime procedures performed by surgeons who had more than 6 hours of sleep (OR 1.72, 95% CI 1.02–2.89). Postnighttime procedures completed after working more than 12 hours (n = 958) compared with 12 hours or fewer (n = 918) had nonsignificantly higher complication rates (6.5% v. 4.3%; OR 1.47, 95% CI 0.96–2.27). Conclusion: Overall, procedures performed the day after attending physicians worked overnight were not associated with significantly increased complication rates, although there was an increased rate of complications for postnighttime procedures performed by physicians who had fewer than 6 hours of sleep.