Ideally, patients and surgeons would never be in a situation where an elective operation needs to happen when a surgeon is fatigued, says the author of a medical journal editorial. (iStock)

People who are getting elective surgery should know how much sleep their doctors have had before going into the operating room, a medical journal editorial says.

Dr. Michael Nurok, an anesthesiologist and intensive-care physician at New York's Hospital for Special Surgery, argues in Thursday's online issue of the New England Journal of Medicine that patients should have a right to information on sleep-deprived doctors.

Patients should also be allowed to ask for another doctor or reschedule their surgery, Nurok said.

"The ideal solution here is that patients and surgeons never are put in the situation where an operation needs to happen when a surgeon is fatigued," Nurok said in an interview with CBC Radio's As It Happens.

Surgeons are more often called unexpectedly to operate in busy urban centres than in rural areas, Nurok said, making urban doctors more likely to be fatigued.

Most countries regulate excessive working hours for trainees, but there is nothing for fully trained physicians, he noted.

The interim step of more rights for patients "may be necessary until institutions take the responsibility for ensuring that patients rarely face such dilemmas," Nurok and two other authors wrote.

The preferred solution would be to not schedule doctors to perform an elective surgery when sleep-deprived in the first place, the authors proposed.

Sleep deprivation hampers clinical performance and increases the risk of complications, the editorial authors said.

Less than 6 hours

A 2009 study in the Journal of the American Medical Association showed a significant increase in the risk of complications in patients who had elective daytime surgical procedures performed by surgeons who had less than a six-hour opportunity for sleep during a previous on-call night.

And people who are sleep-deprived are often not able to accurately assess their degree of self-impairment, which can be as severe as alcohol intoxication, the editorial noted.

The editorial argues that sleep-deprived physicians should be required to inform patients of their condition and the potential hazards that can come with this impairment.

If patients choose to proceed as planned, they should be required to sign a consent form on the day of the procedure in front of a witness.

Patients prepare for elective surgery by taking time off work, making sure they have transportation to the hospital, and fasting for example, said Sholom Glouberman, president of the Patients' Association of Canada.

Months in advance

In Canada, rescheduling an elective surgery as a priority as suggested doesn't necessarily occur, because these appointments are often made months in advance, said Glouberman, who also said that hospitals should take on the scheduling responsibility.

Michael McBane, national co-ordinator of the Canadian Health Coalition, said it makes sense that doctors should disclose their fatigue, given that health-care professionals face time pressures in both Canada and the U.S.

"I do think patients should know if the doctor's been up for 22 hours. They should be informed of that, because obviously it affects their performance and their judgment," McBane told The Canadian Press from Ottawa.

McBane suggested problems can occur when the system becomes fixated on wait-time guarantees and the quantity of procedures, instead of the quality and appropriateness of interventions.

A second paper appearing in the same issue of the journal reviews general anesthesia, sleep and coma.

A fully anesthetized brain is much closer to the deeply unconscious low-brain activity seen in coma patients, than to a person asleep, the review suggested. The researchers aim to explore different ways to safely place the brain into a "reversible coma" with fewer side-effects and risks than current forms of general anesthesia.

The U.S. National Institutes of Health and James S. McDonnell Foundation funded the review by Dr. Nicholas Schiff, a professor of neurology and neuroscience at New York's Weill Cornell Medical College, and his two co-authors.

With files from The Canadian Press