Fatigued surgeons: a thematic analysis of the causes, effects and opportunities for fatigue mitigation in surgery

Background:High-pressured situations, coupled with diminished resource allocations and over-workedstaff have been characteristic of surgery for a long time before the COVID-19 pandemic. Understandingthe cause and effects of fatigue in the profession are warranted to design evidence-based and effectiveinterventions for fatigue mitigation. By identifying the individual stressors to individuals fatigue levels,tailored approaches to better optimise performance can be established.Methods:This was a single-site qualitative study design using an interpretive, iterative and thendeductive thematic analysis approach. Participants were recruited between February 2020eMay 2020. Aconvenience, followed by purposive sampling strategy was employed to inform theoretical gaps onsurgical trainees and consultants.Findings:There are commonalities in the influencing factors between both fatigue and sleep deprivation.It was identified that often the combination of fatigue and sleep stressors blurs the line betweenidentifying what is primarily influencing subjective fatigue. There was an appreciation that the perfectstorm of personal and environmental stressors could impact patient safety. Participants identified severalpersonal mitigators for technical and cognitive performance, but relied more heavily on team factors fordecision-making and to mitigate affective issues.Conclusion:This study provides understanding of fatigue in surgery as a multifaceted phenomenon.Variation in causes and effects of fatigue are the norm. Maladaptive strategies to mitigate fatigue insurgery are commonly used. Fatigue as a problem is best tackled at an individual level, and supported byenvironmental and systemic changes to sustain behaviour changes