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Original Investigation
October 11, 2018

Association Between Surgical Trainee Daytime Sleepiness and Intraoperative Technical Skill When Performing Septoplasty

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
  • 3Facial Plastic SurgiCenter, Baltimore, Maryland
  • 4Department of Surgery, Washington DC Veterans Affairs Medical Center
  • 5Department of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC
JAMA Facial Plast Surg. 2019;21(2):104-109. doi:10.1001/jamafacial.2018.1171
Key Points

Question  What is the association between daytime sleepiness and intraoperative technical skill among surgical trainees performing nasal septoplasty?

Findings  In this cohort study of 19 surgical trainees participating in septoplasty procedures, increased daytime sleepiness was associated with statistically significant lower technical skill scores as rated by supervising attending physicians.

Meaning  Daytime sleepiness of surgical trainees may be inversely associated with intraoperative technical skill when performing septoplasty.


Importance  Daytime sleepiness in surgical trainees can impair intraoperative technical skill and thus affect their learning and pose a risk to patient safety.

Objective  To determine the association between daytime sleepiness of surgeons in residency and fellowship training and their intraoperative technical skill during septoplasty.

Design, Setting, and Participants  This prospective cohort study included 19 surgical trainees in otolaryngology–head and neck surgery programs at 2 academic institutions (Johns Hopkins University School of Medicine and MedStar Georgetown University Hospital). The physicians were recruited from June 13, 2016, to April 20, 2018. The analysis includes data that were captured between June 27, 2016, and April 20, 2018.

Main Outcomes and Measures  Attending physician and surgical trainee self-rated intraoperative technical skill using the Septoplasty Global Assessment Tool (SGAT) and visual analog scales. Daytime sleepiness reported by surgical trainees was measured using the Epworth Sleepiness Scale (ESS).

Results  Of 19 surgical trainees, 17 resident physicians (9 female [53%]) and 2 facial plastic surgery fellowship physicians (1 female and 1 male) performed a median of 3.00 septoplasty procedures (range, 1-9 procedures) under supervision by an attending physician. Of the 19 surgical trainees, 10 (53%) were aged 25 to 30 years and 9 (47%) were 31 years or older. The mean ESS score overall was 6.74 (95% CI, 5.96-7.52), and this score did not differ between female and male trainees. The mean ESS score was 7.57 (95% CI, 6.58-8.56) in trainees aged 25 to 30 years and 5.44 (95% CI, 4.32-6.57) in trainees aged 31 years or older. In regression models adjusted for sex, age, postgraduate year, and technical complexity of the procedure, there was a statistically significant inverse association between ESS scores and attending physician–rated technical skill for both SGAT (−0.41; 95% CI, −0.55 to −0.27; P < .001) and the visual analog scale (−0.75; 95% CI, −1.40 to −0.07; P = .03). The association between ESS scores and technical skill was not statistically significant for trainee self-rated SGAT (0.04; 95% CI, −0.17 to 0.24; P = .73) and the self-rated visual analog scale (0.19; 95% CI, −0.79 to 1.2; P = .70).

Conclusions and Relevance  The findings suggest that daytime sleepiness of surgical trainees is inversely associated with attending physician–rated intraoperative technical skill when performing septoplasty. Thus, surgical trainees’ ability to learn technical skill in the operating room may be influenced by their daytime sleepiness.

Level of Evidence  NA.