A Pilot Study Examining Sleep Deprivation Among Liver Transplant Surgeons. Are Patient Outcomes at Risk?

backgroundTransplant surgery is a physically demanding field with an irregular call schedule. Sleep deprivation and stress have been linked to decreased cognitive abilities; however, their effects on transplant recipient outcomes remain unknown. The goal of this pilot study was to compare liver transplant (LT) recipient outcomes by surgeon sleep deprivation status and stress level.

methodsAttending LT surgeons at a high-volume transplant center wore a biophysical monitor from 12/2022 to 04/2023. Surgeon sleep deprivation and stress level were prospectively measured. All LTs were reviewed up to 90 days posttransplant.

resultsSix surgeons (66.7% male, 50% >5 years of practice) wore a biophysical monitor during 36 LTs. The primary surgeon experienced sleep deprivation 50.0% of the time. Calculated stress level was moderate-to-high during 94.4% of cases. Among the 36 LT performed, all baseline recipient characteristics were similar. Sleep deprived surgeons utilized higher numbers of intraoperative blood products and had higher rates of bile leak within 90 days. On multivariable logistic regression analysis, unplanned reoperation and surgeon sleep deprivation were significant predictors of bile leak.

conclusionThis is the first study evaluating patient outcomes based on sleep deprivation among LT surgeons using a continuous wearable biophysical monitor. Serving as a feasibility study, largely similar patient outcomes were demonstrated despite high rates of sleep deprivation and pervasive stress states for surgeons. Notably, bile leak was associated with surgeon sleep deprivation with comparable odds to reoperation. Using this technology, additional work is warranted to elucidate associations between the physiologic states of surgeons and LT outcomes.