The deliberation over the specific mechanisms
surrounding mandatory disclosure of sleep deprivation does not nullify the requirement to disclose
this information. Adherence to the principles of
beneficence, non-maleficence, and autonomy
should not be contingent upon the creation of policies and plans to deal with the consequences of the
As your mother waits to speak with the surgeon and sign the consent form, you think about
the amount of sleep deprivation your colleague
has sustained. Will this fatigue cause even minor
complications? You begin to wonder what systemic
changes could make this situation more tenable for
you, your surgical colleagues, and your patients. ♦
1. Pellegrini CA, Britt LD, Hoyt DB. Sleep deprivation and
elective surgery. N Engl J Med. 2010;363:2672-2673.
2. Van Dongen HP, Maislin G, Mullington JM, Dinges DF.
The cumulative cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep
physiology from chronic sleep restriction and total sleep
deprivation. Sleep. 2003; 26( 2):117-126.
3. Stutts JC, Wilkins JW, Vaughn BV. Why do people have
drowsy driving crashes? Input from drivers who just did.
November 1999. Available at: www.aaafoundation.org/
sites/default/files/sleep.PDF. Accessed September 12, 2016.
4. Caldwell JA, Mu Q, Smith JK, et al. Are individual
differences in fatigue vulnerability related to baseline
differences in cortical activation? Behav Neurosci.
5. Philibert I. Sleep loss and performance in residents and
nonphysicians: A meta-analytic examination. Sleep. 2005;
6. Rothschild JM, Keohane CA, Rogers S, et al. Risks of
complications by attending physicians after performing
nighttime procedures. JAMA. 2009;302( 14):1565-1572.
7. Vinden C, Nash DM, Rangrej J, et al. Complications
of daytime elective laparoscopic cholecystectomies
performed by surgeons who operated the night before.
JAMA. 2013;310( 17):1837-1841.
8. Govindarajan A, Urbach DR, Kumar M, et al. Outcomes
of daytime procedures performed by attending surgeons
after night work. N Engl J Med. 2015;373:845-853.
9. Makary MA, Daniel M. Medical error—the third leading
cause of death in the U.S. BMJ. 2016;353:i2139.
10. Nurok M, Czeisler CA, Lehmann LS. Sleep deprivation,
elective surgical procedures, and informed consent. N Engl
J Med. 2010;363:2577-2579.
Surgical societies have a duty to draft consensus statements
supporting and outlining the details of mandatory
disclosure. If we don’t create the process, then the terms
will be foisted upon us by a well-meaning but inexperienced
populace supported by nonsurgical groups.