We thank Santini and colleagues for their interest in our research and would like to reply to the comments made in their letter. The effects of physician sleep deprivation on patient care remain a contentious but important issue that requires mandatory evaluation to ensure patient safety. We are not disputing the neurobiological evidence, or the “common sense,” that professes that sleep loss has widespread effects on mood, cognition, and psychomotor function. As a profession, medicine has appropriately identified similar concerns with respect to physician fatigue and medical errors; however, it has been less successful in implementing effective change. Practically speaking, attending physicians work in a challenging environment that demands longer work hours to deliver optimal patient care while balancing other administrative, academic, and educational responsibilities. These are not glamorous duties, nor are they often recognized or reimbursed, but in the “real world,” they are mandatory in most clinical practices. Although we all try to get restful sleep, the patient's needs often supersede our own personal needs and, as a result, occasionally compromise our sleep hours. Rather than simply accepting the status quo, we felt compelled to investigate perioperative outcomes and patient safety within our current work-hour model (not perpetuate “macho behavior”) to ensure that our patients were receiving the highest quality of care.1 We proposed many compensatory mechanisms that may help to account for our findings. Our results do not contradict the physiological effects of fatigue on human performance but simply reassure our patients that their postoperative outcomes were not affected by a surgeon's sleep hours.