Original Investigation 

Surgeon Social Jet Lag and Patient Risk of Major Adverse Events

Léa Pascal, Stéphanie Polazzi, Sarah C. Skinner, et al

JAMA Surg Published Online: June 3, 2026

doi: 10.1001/jamasurg.2026.1796

Key Points

Question  Is surgeon sleep timing regularity associated with patient outcomes?

Findings  In this multispecialty cohort study including 7117 operations performed by 38 surgeons, patients operated on by surgeons with social jet lag of 2 hours or more in the month preceding surgery had a significantly higher risk of major adverse events. This association was independent of surgeon sleep duration, total working hours, and night shift frequency.

Meaning  Maintaining regular sleep timing between workdays and free days for surgeons may represent a modifiable contributor to surgical safety.

Abstract

Importance  Sleep timing regularity is increasingly recognized as a determinant of cognitive performance, yet its influence on surgeons’ well-being and patient safety remains unexplored.

Objective  To evaluate the association between surgeons’ sleep timing regularity and major adverse events in their patients.

Design, Setting, and Participants  This multicenter prospective cohort study was conducted from November 1, 2020, to December 31, 2021, across 14 surgical departments in 7 specialties at 4 university hospitals in France. Patients were excluded if they were younger than 18 years, underwent palliative surgery, had incomplete operative time stamps, or were operated on by surgeons with invalid sleep data. Study data were analyzed from January to June 2025.

Exposures  Surgeons’ sleep was continuously monitored using actigraphy. Sleep timing regularity in the 30 days preceding surgery was quantified using midsleep time (midpoint between bedtime and get-up time). Social jet lag(SJL) was defined as the absolute difference between midsleep times on free days and workdays, and midsleep time variability was the SD of daily midsleep times.

Main Outcomes and Measures  Outcomes included major adverse events within 30 days postoperatively, including inpatient death, prolonged intensive care unit stay, reoperation, or severe complications. Mixed-effects multivariable models were adjusted for surgeon sleep duration, midsleep time, age, sex, professional status, working hours, night shifts, patient case mix (ie, a composite risk score incorporating patient comorbidities and surgery characteristics), and time of incision, with a random effect for surgeons. Surgeon burnout was assessed using the Maslach Burnout Inventory.

Results  Among 7117 operations (7117 patients; mean [SD] age, 55.9 [17.5] years; 3877 female [54.5%]) performed by 38 attending surgeons (mean [SD] age at study start, 46.1 [8.5] years; 30 male [79%]), 1410 (19.8%) resulted in a major adverse event. SJL of 2 or more hours (342 operations [4.8%]; 7 surgeons) was associated with increased risk of major adverse events compared with less than 1 hour (adjusted relative risk [RR], 1.36; 95% CI, 1.04-1.69) and 1 to 2 hours (RR, 1.45; 95% CI, 1.12-1.81). Midsleep time variability of 60 minutes or longer (864 operations [12.1%]; 20 surgeons) was not associated with adverse outcomes. Surgeons with burnout had higher median [IQR] social jet lag (75 [47-94] vs 52 [38-61] minutes; P = .04) and midsleep time variability (54 [44-68] vs 43 [36-48] minutes; P = .01) than those without burnout.

Conclusions and Relevance  Patients operated on by surgeons experiencing substantial social jet lag had a higher associated risk of major adverse events. Interventions promoting regular sleep timing and reducing circadian misalignment may improve surgeon burnout and patient safety.