Surgery often requires intense focus and physical exertion from surgeons for prolonged periods. Some surgical procedures can last many hours, requiring surgeons to be on their feet the entire time. It’s only natural to wonder – do surgeons get tired during long operations?
The Physical Demands of Surgery
Surgery is a physically demanding profession. Surgeons often have to stand in place leaned over an operating table for hours at a time. This forces the back, neck, shoulders and legs to remain stationary in awkward postures that can become uncomfortable. The physical constraints of the operating room also make it difficult for surgeons to move around and stretch.
In addition, surgeons have to perform meticulous work with their hands and fingers while coordinating hand-eye movements. The hands and forearms can become fatigued from repetitive motions. Surgeons also have to wear heavy lead aprons to protect from radiation exposure during procedures using imaging guidance like fluoroscopy or C-arms. The weight of these aprons puts extra strain on the back and neck over time.
At the same time, surgeons need steady hands and precise control of fine motor skills in order to manipulate delicate tissues and suture with micrometer precision. Any fatigue in the hands or arms can negatively impact surgical dexterity and increase the risk of technical errors.
Mental Concentration Required During Surgery
Besides physical demands, surgery also requires intense mental focus and concentration. The surgeon must remain alert and attentive for long stretches of time. There is no room for complacency, as a serious mistake can be life-threatening for the patient.
Surgeons have to simultaneously perform technical skills with their hands while processing complex information from sight, sound and touch. They have to continuously monitor the patient’s vital signs, adjust plans depending on anatomy, and communicate clearly with the surgical team.
This level of sustained vigilance in combination with patient care responsibilities can lead to significant mental fatigue over the course of a lengthy or difficult procedure. However, surgeons must maintain their composure under stress.
Do Surgeons Get Tired During Long Operations?
The strenuous physical and mental workload of surgery certainly contributes to fatigue over the course of long procedures. In a survey published in the Journal of the American College of Surgeons in 2012, researchers found that:
- 87% of surgeons reported physical fatigue during procedures lasting over 4 hours.
- 89% reported mental exhaustion during prolonged operations.
Another study in 2015 analyzed surgeon fatigue during mock operations lasting around 3 hours. The results showed surgeons demonstrated poorer technical skills and cognitive function by the end of the simulated procedures.
However, it is difficult to objectively measure surgeon fatigue and its impacts on performance. More research is still needed using direct measures of physical exertion and vigilance during actual operations.
How Surgeons Counteract Fatigue
Experienced surgeons train and prepare their minds and bodies to endure the rigors of operations. Here are some techniques surgeons use to fight fatigue:
- Physical conditioning – Staying active and fit improves stamina, strength and posture to withstand the physical demands during surgery.
- Proper nutrition and hydration – Eating healthy meals and drinking fluids prevents hunger, thirst and low blood sugar during long cases.
- Breaks when possible – Even short breaks of a few minutes allow the surgeon to stretch, relax and regain focus.
- Ergonomic equipment and posture – Adjustable tables, chairs and high-definition optics can optimize positioning and reduce strain.
- Teamwork – Sharing duties and communicating needs to assistants and staff improves efficiency.
- Experience and pacing – Learning over time how to evenly distribute effort over the full duration of surgery.
However, even the most seasoned surgeons recognize their own physical and mental limitations. When extreme fatigue jeopardizes patient safety, the wise surgeon will postpone or pause the operation if essential.
Do Surgical Errors Increase with Fatigue?
Research has associated surgeon fatigue with adverse impacts on performance. Some studies have found correlations between surgeon fatigue and:
- More surgical errors
- Longer operation times
- Increased blood loss during surgery
- Poorer tissue handling and technical skills
- Lapses in communication, situational awareness and decision making
However, not all studies have found definitive links between fatigue and these outcomes. More high-quality research is still needed to establish clearer relationships using direct, objective measures.
But logically, fatigue impairs motor skills, concentration, memory and other cognitive functions essential for optimal surgical performance. So most surgeons and researchers believe that fatigue likely contributes to more errors, complications and worse patient outcomes over time.
Regulating Surgeon Work Hours
To address concerns over surgeon fatigue, organizations like the Accreditation Council for Graduate Medical Education (ACGME) have instituted duty hour limits for surgical residents and fellows in training. These include:
- 80-hour maximum work week, averaged over 4 weeks
- 1 day off per week, averaged over 4 weeks
- In-hospital call no more frequent than every 3rd night
- 10 hours minimum break between duty periods
However, no such mandatory hour restrictions apply to fully qualified attending surgeons. Professional medical societies emphasize the need for surgeons to self-regulate and not overschedule cases that lead to exhaustion.
Some hospitals are also creating updated policies regarding surgeon call schedules, night float systems and other arrangements to better allow for adequate rest between intense operating room duties.
Options to Reduce Surgeon Fatigue
Here are some additional strategies hospitals and surgical departments can implement to help mitigate surgeon fatigue:
- Stagger surgeon call and operating schedules to build in days with lighter workloads.
- Monitor and optimize surgeon schedules and procedural volumes to prevent overload.
- Provide lounge areas and sleep rooms for surgeons to rest while on call.
- Ensure backup call support from other qualified surgeons when needed.
- Allow brief refreshment and stretch breaks during marathon cases when possible.
- Supply ergonomic seats, anti-fatigue mats and other accessories to improve comfort.
- Rotate assistants more frequently during prolonged procedures.
With proper scheduling, staff support and experience, surgeons can take precautions against excessive physical and mental fatigue during surgery. But inevitably, long and complex operations will subject even the most seasoned surgeons to taxing demands on their minds and bodies.
Conclusion
Surgery involves strenuous and sustained physical work coupled with intense mental concentration. During procedures lasting many hours, most surgeons experience significant fatigue which can impact their performance. While training and experience help surgeons adapt to the demanding workload, fatigue is an inevitable part of the job.
More studies validating the effects of surgeon fatigue could lead to wider adoption of work hour regulations and hospital policies to ensure patient safety. But ultimately, surgeons themselves must learn their own limitations and act responsibly when they recognize that fatigue is compromising their skills or judgement during an operation.