There is a paucity of evidence investigating the effects of sleep loss and fatigue on the performance of surgeons and subsequent clinical outcomes. The overall weight of (poor) evidence shows that clinical, academic, and cognitive performance are not proven to be affected by sleep deprivation or fatigue and that psychomotor performance may or may not be. Variations in results were in some cases attributable to the level of training of participants, and between-subject differences. Many studies used surrogate markers to measure performance, although the relationship between these markers to actual clinical performance is unclear. It appears that fatigue can be compensated for in the acute operating room setting, but it is unclear what impact it has on normal functions. The search strategy did not identify any economic evaluations, resulting in an inability to comment on the financial effect of fatigue on surgery and surgical training.
We acknowledge that it would be beneficial to compare the results of this systematic review with data from professions other than the field of surgery. A systematic assessment of fatigue in other professions, such as aeronautics, transport, military and shift workers, was beyond the scope of this current assessment but, where available, have generally demonstrated similar findings to this review, although individual reports written within these industries do suggest detrimental effects of fatigue on performance.