The impact of sleep deprivation in military surgical teams: a systematic review
Open accessAbstract
Background Fatigue in military operations leads to safety and operational problems due to a decrease in alertness and performance. The primary method of counteracting the effects of sleep deprivation is to increase nightly sleep time, which in operational situations is not always feasible. History has taught us that surgeons and surgical teams are finite resources that cannot operate on patients indefinitely. Methods A systematic review was conducted using the search terms ‘sleep’ and ‘deprivation’ examining the impact of sleep deprivation on cognitive performance in military surgical teams. Studies examining outcomes on intensive care patients and subjects with comorbidities were not addressed in this review. Results Sleep deprivation in any ‘out-of-hours’ surgery has a significant impact on overall morbidity and mortality. Sleep deprivation in surgeons and surgical trainees negatively impacts cognitive performance and puts their own and patients' health at risk. All published research lacks consensus when defining ‘sleep deprivation’ and ‘rested’ states. It is recognised that it would be unethical to conduct a well-designed randomised controlled trial, to determine the effects of fatigue on performance in surgery; however, there is a paucity between surrogate markers and applying simulated results to actual clinical performance. This requires further research. Recommended methods of combating fatigue include: prophylactically ‘sleep-banking’ prior to known periods of sleep deprivation, napping, use of stimulant or alerting substances such as modafinil, coordinated work schedules to reduce circadian desynchronisation and regular breaks with enforced rest periods. Conclusions A forward surgical team will become combat-ineffective after 48 hours of continuous operations. This systematic review recommends implementing on-call periods of no more than 12 hours in duration, with adequate rest periods every 24 hours. Drug therapies and sleep banking may, in the short term, prevent negative effects of acute sleep deprivation.
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Research on sleep disturbances among military MDs is scarce and consistent data are lacking.
“Regarding sleep disturbances among military MDs, research is scarce, and consistent data are lacking.”
From Sleep disturbances and psychological well-being among military medical doctors of the Swiss Armed Forces: study protocol, rationale and development of a cross-sectional and longitudinal interventional study (2024) · cites this paper as [73]
The Conclusion says the evidence base on sleep deprivation in surgical teams is weak, citing inconsistent definitions and gaps between simulated results and clinical practice. The Sleep deprivation section likewise describes inconsistencies that limit the research. The review does not establish that research on sleep disturbances among military physicians generally is scarce; its scope is sleep deprivation and performance in military and civilian surgical teams. (LLM, conf=0.85)
Experimental — accuracy not yet measuredForward surgical teams become combat-ineffective after 48 h of continuous operations.
“forward surgical teams will become combat-ineffective after 48 h of continuous operations (73).”
Sleep deprivation in military physicians negatively impacts their cognitive performance and puts their own and patients' health at risk.
“Sleep deprivation in surgeons and surgical trainees did negatively impact on their cognitive performance, putting their own and patients’ health at risk.”
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“More specifically, forward surgical teams will become combat-ineffective after 48 h of continuous operations (73).”
Background
- Authors
- Parker, R. S., & Parker, P.
- Affiliations
- Royal Preston Hospital (GB)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Corresponding author
- Parker, P
- Venue
- Journal of the Royal Army Medical Corps
- Publisher
- BMJ
- Published
- 2016-09-13
- Volume
- 163
- Issue
- 3
- Pages
- 158-163
- ISSN
- 0035-8665 (ISSN-L)
- 2052-0468
- OpenAlex
- W2519877104
- Cited by
- 47
- References
- 34
- Citations by year
- 2026: 1 · 2025: 9 · 2024: 4 · 2023: 6 · 2022: 2 · 2021: 10 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 2
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the Royal Army Medical Corps (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- sleep deprivation, military surgery, surgical team, fatigue, cognitive performance, out-of-hours surgery, napping, modafinil, rest periods, surgical residents
- MeSH terms
- Modafinil, Benzhydryl Compounds, Clinical Competence, Cognition, Fatigue, Health Personnel, Humans, Military Medicine, Military Personnel, Patient Care Team, Rest, Sleep, Sleep Deprivation, Task Performance and Analysis, Wakefulness-Promoting Agents, Surgeons
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