nvited Commentary
Sleep, Burnout, and Surgery—Are Medical Errors an Adverse Effect?
Jamie J. Coleman, Mitchell J. Cohen
JAMA Surg Published Online: June 3, 2026
doi: 10.1001/jamasurg.2026.1807
Historically, sleep research and sleep hygiene recommendations have focused on sleep duration—the total amount of sleep obtained per night. Public health guidance has emphasized optimal ranges of sleep duration and promoted behaviors that help people achieve these targets. Among surgeons and other clinicians with overnight call, the dominant proposed strategy for missed sleep has been naps and extended sleep on noncall nights. However, real-world study has demonstrated these strategies are underused, and evidence of recovery is minimal.1
Emerging evidence now highlights sleep regularity as a distinct component of healthy sleep.2 Sleep regularity, defined as the day-to-day consistency of sleep onset and wake times, appears to be as important and potentially more important than sleep duration in cardiometabolic risk, mood regulation, and cognitive performance.2,3 The circadian system functions optimally when behavioral rhythms are stable. Irregular sleep schedules disrupt circadian alignment and contribute to downstream physiological dysregulation. These findings support a multidimensional view of sleep health, with sleep regularity as an important target for interventions.
Social jet lag, used by Pascal and colleagues,4 captures a form of sleep regularity and addresses the interaction between biological sleep timing and socially imposed obligations, such as work. It is defined as the discrepancy of sleep timing between workdays and nonworkdays. In essence, social jet lag quantifies the misalignment between an individual’s endogenous circadian rhythms and socially determined sleep timing.
Although poor-quality sleep reliably impairs cognitive performance in laboratory settings, prior literature has not clearly linked postoperative complications to surgeon fatigue or on-call duties.5,6 Pascal et al4 evaluated this association between quality of care and surgeon health in a novel way, incorporating contemporary insights about the importance of sleep timing. They found a significant increase in major adverse events in operations performed by surgeons with severe social jet lag, defined as greater than 2 hours over the preceding month. Surgeons with severe social jet lag also had a lower total amount of sleep in that month.
It is important to highlight that this study obtained burnout data on participating surgeons, an essential metric to include as surgeon burnout is known to be associated with higher complication rates, a 2.5-fold increased risk of medical errors, and doubling of patient safety events.7,8 Surgeons with burnout, defined by high emotional exhaustion and/or high depersonalization, had higher levels of social jet lag.
This study4 underscores the complex interplay between sleep duration, sleep timing, burnout, and postoperative complications, representing an important advance in understanding how sleep affects surgical performance. Taken together with prior work on sleep and burnout, these findings should serve as a wake-up call: rest and recovery are not signs of weakness but core components of optimizing surgical performance.
