Effect of fatigue on laparoscopic skills: a comparative historical cohort study. Issue 3 (27th January 2013)

• Record Type: Journal Article
• Authors: Daruwalla, Jurstine; Marlow, Nicholas; Field, John; Altree, Meryl; Babidge, Wendy; Hewett, Peter; Maddern, Guy J.
• Is Part Of: ANZ journal of surgery. Volume 84:Issue 3(2014)
• Page Start: 137
• Page End: 142
• Publication Date: 2013-01-27
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.12069
• Languages: English
• ISSNs: 1445-1433

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="ans12069-sec-0001" sec-type="section"> <title>Background</title> <p>Fatigue has been shown to have a negative impact on surgical performance. However, there is a lack of research investigating its effect on laparoscopy, particularly in Australia. This study investigated whether fatigue associated with a surgeon's usual workday led to a measurable drop off in laparoscopic surgical skills as assessed on a laparoscopic simulator.</p> </sec> <sec id="ans12069-sec-0002" sec-type="section"> <title>Methods</title> <p>A comparative study involving two cohorts was undertaken: a study group whose data were collected prospectively was compared to a historical control group. Participants were required to reach a predetermined level of proficiency in each laparoscopic task on either a FLS or LapSim simulator. The participants in the study cohort were re‐tested approximately 1 month after completing 10 h of work. The participants in the historical non‐fatigued group were re‐tested approximately 1 month after reaching proficiency. Comparisons between cohorts were made using a 'decrease in score per day elapsed' value to account for the natural attrition in skills over time and the variability in testing times within and between the two cohorts.</p> </sec> <sec id="ans12069-sec-0003" sec-type="section"> <title>Results</title> <p>The decrease in overall score per day elapsed for fatigued participants was significantly greater than for historical non‐fatigued participants, irrespective of the simulator type. Fatigue had a greater impact on certain laparoscopic skills, including peg transfer and knot tying. Participants who self‐reported higher level of fatigue demonstrated significantly better skills than those who self‐reported lower levels.</p> </sec> <sec id="ans12069-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Overall laparoscopic skill proficiency was reduced in the fatigued participants compared to the historical non‐fatigued participants, with certain laparoscopic skills more affected than others.</p> </sec> </abstract>