Home Call and Sleep in Orthopaedic Surgeons

Abstract

Background: – The effect of home call on the sleep of orthopaedic residents and attending surgeons remains unquantified, despite known negative impacts of poor sleep on cognition, fine motor skills, and decision-making. We prospectively measured the impact of home call on orthopaedic surgery residents’ and attending surgeons’ sleep patterns (total sleep, slow-wave sleep [SWS], and rapid eye movement [REM] sleep), as well as on heart rate variability (HRV). We hypothesized that orthopaedic home call would negatively impact all phases of sleep and suppress post-call HRV.Methods: – Fourteen orthopaedic attending surgeons and 16 orthopaedic surgery residents taking home call at multiple Level-I trauma centers in a single program wore WHOOP 3.0 Straps. The WHOOP Strap objectively measures and quantifies total sleep, SWS, and REM sleep. Over a 13-month period, home call nights were prospectively recorded and matched with physiological data to compare on-call, post-call night 1 (PCN 1), and PCN 2 metrics. Fixed-effects regression models were used for statistical analysis.Results: – Over 13 months, we observed 4, 574 recorded nights of residents’ sleep and 3, 573 recorded nights of attending surgeons’ sleep. The mean baseline (non-call night) sleep parameters were highly varied among individuals. Overall, the mean sleep time was significantly shorter (p < 0.001) for attending surgeons (6.0 hours) than for residents (6.7 hours). When on home call, residents’ total sleep decreased by 20% from baseline (p < 0.001), REM sleep decreased by 12% (p < 0.001), and SWS decreased by 12% (p < 0.001). For attending surgeons, total sleep on call decreased by 10% from baseline (p < 0.001), REM sleep decreased by 7% (p < 0.001), and SWS decreased by 4% (p < 0.01).Conclusions: – Orthopaedic surgery residents and attending surgeons exhibited low baseline sleep, and taking home call reduced this further. This suggests that there is a previously unmeasured toll of home call on orthopaedic surgeons, upon which further research is required to ensure excellent patient care, maximize educational environments, and develop strategies for resilience.Level of Evidence: – Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.