Surgeon Sleep Deprivation, Surgical Complications, and the Ethical Imperatives of Evidence-Based Persuasion.

A proposed relationship between surgeon sleep deprivation (SSD) and increased patient complications is examined through a review of published studies and application of standards of evidence-based persuasion.Published studies of SSD and patient complications were analyzed to evaluate reported relationships between SSD and surgical complications. The basis of a reported "83% increase" in patient complication associated with SSD was reexamined at its original data source.Two proposals to regulate and reorganize surgical practices based on assumptions of increased patient complications associated with SSD were analyzed to clarify the relationship of these proposals to publish data on SSD and standards of evidence-based persuasion.No published study established a relationship between SSD and increased surgical complications.The "83%" increase was a claim based on a subset of data from a single study. This subset analysis was compromised by unvalidated categories, unfounded extrapolation, and failure to reconcile this single observation with the mass of contradictory data.Regulatory proposals based on presumptions of association between SSD and increased surgical complications fail the criteria of evidence-based persuasion. Specifically, the proposals fail to impart impartial evidence-based information, a rational interpretation of evidence, and avoidance of new bias creation.No clear evidence associated SSD with increased surgical complications.Proposals to regulate surgical practices relative to SSD cannot claim to be based on claims of increased SSD-related patient complications. Such proposals, if implemented, should be monitored to determine if regulations increase patient complications relative to current practice.