Was Your Surgeon Drinking Last Night?

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Undergoing surgery is scary enough, but what if your surgeon was out drinking the night before your procedure. How much confidence would you have in the doctor’s surgical skills? Results of a new study indicate that chances are, those operating skills would be impaired.

How much did your doctor drink last night?

Previous research has looked at the impact of a lack of sleep on surgeons’ clinical performance, and some doctors believe patients should be told if their surgeon is sleep-deprived. A study published in the Journal of the American Medical Association noted that procedures done by surgeons who had less than six hours of sleep had an increased risk of organ damage, wound failure, and bleeding.

Now two small studies have looked at the impact of drinking on surgical performance by experienced laparoscopic surgeons and students. According to Anthony G. Gallagher, PhD, of the Royal College of Surgeons National Surgical Training Center in Dublin, Ireland, and his investigative team, operating skills were impaired until as late as 4 PM on the day after surgeons were drinking.

The first of the studies involved 16 science students who ate dinner and were randomized to avoid alcohol or to drink alcohol until subjectively intoxicated. In the second study, eight laparoscopic surgeons had dinner and drank until they felt intoxicated. None of the surgeons was on duty that night or the following day.

Both the students and the surgeons completed a test in a surgical simulator before their dinner and alcohol consumption as well as after. The test included six complex tasks that are typically performed by laparoscopic surgeons. All the students were adequately trained on the simulator before the study began.

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A breathalyzer was used to identify blood alcohol levels immediately before the participants performed the test, which was given at 9AM, 1PM, and 4PM the day following alcohol consumption. The researchers looked at the time it took for the participants to complete the tasks, mean number of errors they made per task, and efficiency of diathermy (a procedure involving heating of body tissue).

Overall, surgical performance declined significantly from baseline in all the surgeons and the students. More specifically, students who drank alcohol had significantly worse performance on diathermy and made significantly more errors than students who did not drink. Students who drank also took longer to complete the test tasks, but the difference was only significant at the 9 AM test.

Among the surgeons, their diathermy scores grew worse as the day progressed, and they did significantly worse on all three tests compared with their baseline scores. They also made significantly more errors when compared with baseline. Performance time was significantly worse at 1 PM but returned to baseline levels by the 4 PM test.

Because laparoscopic surgery presents surgeons with “considerable cognitive, perceptual, visuospatial, and psychomotor challenges,” the authors concluded that “abstinence from alcohol the night before operating may be a sensible consideration for practicing surgeons.”

The fact the authors concluded that avoiding alcohol before performing surgery “may be a sensible consideration” for surgeons is worrisome. Perhaps the question “Was your surgeon drinking last night?” should be posed to surgeons who have a loved one scheduled for a laparoscopic procedure. Would they want the surgery performed by a surgeon who had been drinking the night before the procedure?

In addition to knowing your surgeon’s educational background and surgical record, you might be curious whether he or she was drinking the night before your procedure or even how much sleep he or she got. Unfortunately, according to the authors, “there are no rules or guidelines to govern consumption of alcohol the night before operative duties.”

SOURCES:
Gallagher AG et al. Archives of General Surgery 2011; 146:419-26
Rothschild JM et al. Journal of the American Medical Association 2009; 302: 1565-72

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